Highlights
- •Aligners alone are biomechanically inadequate for requisite clinical tooth movements.
- •Temporary anchorage devices (TADs), attachments, buttons, power arms, or Computer-Aided Design (CAD) / Computer-Aided Manufacturing (CAM), appliances, bootstrap, Yin-Yang attachments, Bene/Mesialslider, and BMX expander, few of the creative adjuncts described.
- •The “Golden Circle Model” of “WHY, HOW, and WHAT” with adjuncts explained.
- •Classification of adjunct applications provided, Adjuncts described can be used concomitantly with aligners or as a separate phase before aligners.
- •Workflow with adjuncts has been described in detail along with clinical recommendations.
ABSTRACT
Clear aligners are the most debated infusion of technology into the orthodontic stratosphere
and currently account for a sizable chunk of the orthodontic commercial market. Data
indicate that a series of plastic aligners alone cannot resolve all the variants of
malocclusion routinely treated by our specialty. Current literary consensus exists
that the discrepancy between the predicted and actual clinical outcomes with clear
aligner therapy (CAT) is around 50% or more, necessitating midcourse corrections,
refinement, or additional aligners, or even a conversion to fixed appliances before
the end of treatment. A practical panacea to improve the predictability of CAT is
the addition of creative and customized adjuncts to CAT. This article, inspired by
the “Golden Circle Model”, addresses questions such as the “WHY, HOW, and WHAT” of
adjuncts used in combination with CAT and depicts an “inside out” approach (from WHY
to WHAT) to present the rationale, stepwise clinical workflow, and the advantages
of these adjuncts. The bootstrap, mini pin-supported mesialization or distalization,
Yin-Yang attachments, Beneslider, Mesialslider, BMX Expander, and Computer-Aided Design
(CAD) / Computer-Aided-Manufacturing (CAM)...based innovative appliance designs among
others, are presented as adjuncts to CAT in this article. These adjuncts can either
be used concomitantly with the aligners or planned as a separate phase of treatment
before the commencement of the actual CAT, based on the type of tooth movement required
and whether the planned tooth movement is indicated for a single tooth or a group
of teeth. An astute clinician who wishes to expand the repertoire of malocclusions
that can be successfully managed by CAT should judiciously plan the inclusion of such
adjunct appliances in their aligner treatment planning.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the World Federation of OrthodontistsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Up in the air: orthodontic technology unplugged! APOS Trends Orthod. 2017; 7: 1-5
- Digital technologies in orthodontics-an update.Semin Orthod. 2018; 24: 373-375
- Lets talk aligners! APOS Trends.Orthod. 2016; 6: 177-178
- The emperor's new clothes! APOS.Trends Orthod. 2019; 9: 1-3
- Biomechanics of clear aligners: hidden truths & first principles.J World Fed Orthod. 2022; 11: 12-21
- Drastic plastic: enhancing predictability of clear aligners.Controversial topics in orthodontics: can we reach consensus? Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor2020: 219-249
- Evolution of the efficiency and predictability of clear aligner therapy.Int J Curr Res. 2020; 12: 13074-13079
- Effect of clear aligner wear protocol on the efficacy of tooth movement.Angle Orthod. 2021; 91: 157-163
- Has Invisalign improved? A prospective follow-up study on the efficacy of tooth movement with Invisalign.Am J Orthod Dentofacial Orthop. 2020; 158: 420-425
- Emerging insights and new developments in clear aligner therapy: a review of the literature.AJO-DO Clin Companion. 2022; 2: 311-324
- Outcomes of clear aligner treatment with and without Dental Monitoring: a retrospective cohort study.Am J Orthod Dentofacial Orthop. 2021; 159: 453-459
- Start With Why: how great leaders inspire everyone to take action.Portfolio, London2009
- Tip, Torque & Rotations: how accurately do digital superimposition software packages quantify tooth movement?.Prog Orthod. 2022; 23
- Effectiveness of clear aligner therapy for orthodontic treatment: a systematic review.Orthod Craniofac Res. 2020; 23: 133-142
- Clear aligners generations and orthodontic tooth movement.J Orthod. 2016; 43: 68-76
- Accuracy of clear aligners: a retrospective study of patients who needed refinement.Am J Orthod Dentofacial Orthop. 2018; 154: 47-54
- Clear aligner orthodontic therapy of rotated mandibular round-shaped teeth: a finite element study.Angle Orthod. 2020; 90: 247-254
- Essential attributes of clear aligner therapy in terms of appliance configuration, hygiene, and pain levels during the pandemic: a brief review.Pain Res Manag. 2020; 20206677929
- Improving the predictability of clear aligners.Semin Orthod. 2017; 23: 65-75
Nicozisis J. The Yin-yang attachment: the clear path to molar zen. The Progressive Orthodontist. Published 2017. Available from: https://princetonorthodontics.net/wp-content/uploads/2019/05/Nicozisis-Ying-Yang-Final.pdf [Accessed Month day, year].
- A customized staging procedure to improve the predictability of space closure with sequential aligners.J Clin Orthod. 2014; 48: 359-367
- Application and effectiveness of the Beneslider: a device to move molars distally.World J Orthod. 2010; 11: 331-340
- Combination of clear aligners and Beneslider for correction of severe midline deviation.J Clin Orthod. 2021; 55: 675-683
- Treatment of maxillary transversal deficiency by using a mini-implant-borne rapid maxillary expander and aligners in combination.Am J Orthod Dentofacial Orthop. 2021; 160: 147-154
- Maxillary Space Closure Using Aligners and Palatal Mini-Implants in Patients with Congenitally Missing Lateral Incisors.J Clin Orthod. 2021; 55: 20-33
- Approaching complex orthodontic treatment cases using aligners in combination with skeletal anchorage.Journal of Aligner Orthodontics. 2022; 6: 1-18
- CAD/CAM Metallic Printing of a Skeletally Anchored Upper Molar Distalizer.J Clin Orthod. 2020; 54: 140-150
- The T-Zone: median vs. paramedian Insertion of palatal Mini-Implants.J Clin Orthod. 2016; 50: 543-551
Article info
Publication history
Published online: November 15, 2022
Accepted:
October 13,
2022
Received:
October 5,
2022
Footnotes
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests: Authors have completed and submitted the ICMJE Form for Disclosure of potential conflicts of interest. None declared.
Provenance and peer review: Commissioned; Internally peer reviewed.
Identification
Copyright
© 2022 World Federation of Orthodontists. Published by Elsevier Inc. All rights reserved.
