Effectiveness of Clear Aligners in Achieving Proclination and Intrusion of Incisors Among Class II Division 2 Patients: a Multivariate Analysis

Overview

Journal Prog Orthod

Publisher Springer

Specialty Dentistry

Date 2023 Apr 3

PMID 37009943

Authors

Xinyu Yan

Xiaoqi Zhang

Linghuan Ren

Yi Yang

Qingxuan Wang

Yanzi Gao

Qingsong Jiang

Fan Jian

Hu Long

Wenli Lai

Affiliations

Soon will be listed here.

Abstract

Background: The predictability of incisor movement achieved by clear aligners among Class II division 2 patients is poorly understood. The aim of this retrospective study was to determine the effectiveness of clear aligners in proclining and intruding upper incisors and its influencing factors.

Methods: Eligible patients with Class II division 2 malocclusion were included. For clear aligner therapy, three types of incisor movements were designed: proclination, intrusion and labial movement. Pre-treatment and post-treatment dental models were superimposed. The differences between predicted and actual (DPA) tooth movement of incisors were analyzed. Univariate and multivariate linear regression were used to analyze the potential influencing factors.

Results: A total of 51 patients and their 173 upper incisors were included. Actual incisor proclination and intrusion were less than predicted ones (both P < 0.001), while actual labial movement was greater than predicted one (P < 0.001). Predictability of incisor proclination and intrusion was 69.8% and 53.3%, respectively. Multivariate linear regression revealed that DPA of proclination was significantly positively associated with predicted proclination (B = 0.174, P < 0.001), ipsilateral premolar extraction (B = 2.773, P < 0.001) and ipsilateral canine proclination (B = 1.811, P < 0.05), while negatively associated with molar distalization (B = - 2.085, P < 0.05). The DPA of intrusion was significantly positively correlated with predicted intrusion (B = 0.556, P < 0.001) while negatively associated with labial mini-implants (B = - 1.466, P < 0.001). The DPA of labial movement was significantly positively associated with predicted labial movement (B = 0.481, P < 0.001), while negatively correlated with molar distalization (B = - 1.004, P < 0.001), labial mini-implants (B = - 0.738, P < 0.001) and age (B = - 0.486, P < 0.05).

Conclusions: For Class II division 2 patients, predicted incisor proclination (69.8%) and intrusion (53.3%) are partially achieved with clear aligner therapy. Excessive labial movement (0.7 mm) of incisors may be achieved. Incisor movement is influenced by predicted movement amount, premolar extraction, canine proclination, molar distalization, mini-implants and age.

Citing Articles

Expert consensus on the clinical strategies for orthodontic treatment with clear aligners.

Wang Y, Long H, Zhao Z, Bai D, Han X, Wang J Int J Oral Sci. 2025; 17(1):19.

PMID: 40074738 PMC: 11904224. DOI: 10.1038/s41368-025-00350-2.

Biomechanical analysis of clear aligners for mandibular anterior teeth intrusion and its clinical application in the design of new aligner attachment.

Xiao S, Cheng C, Li H, Li L, Shen C, Feng Q Prog Orthod. 2025; 26(1):11.

PMID: 40059251 PMC: 11891119. DOI: 10.1186/s40510-025-00557-3.

Teenage Patients with Class II Subdivision Treated with Aligners and Elastics: A Retrospective Study.

Quinzi V, Conigliaro A, Fani E, Meme L, Fiasca F, Carugo N Medicina (Kaunas). 2025; 60(12.

PMID: 39768968 PMC: 11678840. DOI: 10.3390/medicina60122089.

An Evaluation of the Estimated Aligners Needed to Correct Malocclusion Traits Using Invisalign ClinCheck™ Pro Software: A Retrospective Study.

Rincon-Gregor I, Bautista-Rojas C, Trejo-Ake E, Zuniga-Herrera I, Herrera-Atoche J J Clin Med. 2024; 13(21).

PMID: 39518691 PMC: 11546783. DOI: 10.3390/jcm13216552.

A Bibliometric Analysis of Clear Aligner Treatment (CAT) From 2003 to 2023.

He X, Huang Z, Yang Y, Yuan X, Wen S, Li Y Cureus. 2024; 16(6):e63348.

PMID: 39077282 PMC: 11283927. DOI: 10.7759/cureus.63348.

References

Hahn W, Zapf A, Dathe H, Fialka-Fricke J, Fricke-Zech S, Gruber R . Torquing an upper central incisor with aligners--acting forces and biomechanical principles. Eur J Orthod. 2010; 32(6):607-13. DOI: 10.1093/ejo/cjq007. View

Jiang T, Jiang Y, Chu F, Lu P, Tang G . 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; 159(5):635-643. DOI: 10.1016/j.ajodo.2019.11.025. View

Kravitz N, Kusnoto B, BeGole E, Obrez A, Agran B . How well does Invisalign work? A prospective clinical study evaluating the efficacy of tooth movement with Invisalign. Am J Orthod Dentofacial Orthop. 2009; 135(1):27-35. DOI: 10.1016/j.ajodo.2007.05.018. View

Krieger E, Seiferth J, Marinello I, Jung B, Wriedt S, Jacobs C . Invisalign® treatment in the anterior region: were the predicted tooth movements achieved?. J Orofac Orthop. 2012; 73(5):365-76. DOI: 10.1007/s00056-012-0097-9. View

Komiya T, Powell E, Vu C, Guddati A . Role of T0 status in overall survival for unresectable stage III non-small cell lung cancer: A NCDB analysis. Radiother Oncol. 2020; 148:8-13. DOI: 10.1016/j.radonc.2020.03.021. View

Xu Z, Jing J, Ma G . Development and validation of prognostic nomogram based on log odds of positive lymph nodes for patients with gastric signet ring cell carcinoma. Chin J Cancer Res. 2021; 32(6):778-793. PMC: 7797227. DOI: 10.21147/j.issn.1000-9604.2020.06.11. View

Simon M, Keilig L, Schwarze J, Jung B, Bourauel C . Treatment outcome and efficacy of an aligner technique--regarding incisor torque, premolar derotation and molar distalization. BMC Oral Health. 2014; 14:68. PMC: 4068978. DOI: 10.1186/1472-6831-14-68. View

Patterson B, Foley P, Ueno H, Mason S, Schneider P, Kim K . Class II malocclusion correction with Invisalign: Is it possible?. Am J Orthod Dentofacial Orthop. 2020; 159(1):e41-e48. DOI: 10.1016/j.ajodo.2020.08.016. View

Liu L, Zhan Q, Zhou J, Kuang Q, Yan X, Zhang X . Effectiveness of an anterior mini-screw in achieving incisor intrusion and palatal root torque for anterior retraction with clear aligners. Angle Orthod. 2021; 91(6):794-803. PMC: 8549549. DOI: 10.2319/120420-982.1. View

10.

Millett D, Cunningham S, OBrien K, Benson P, De Oliveira C . Orthodontic treatment for deep bite and retroclined upper front teeth in children. Cochrane Database Syst Rev. 2018; 2:CD005972. PMC: 6491166. DOI: 10.1002/14651858.CD005972.pub4. View

11.

Al-Khateeb E, Al-Khateeb S . Anteroposterior and vertical components of class II division 1 and division 2 malocclusion. Angle Orthod. 2009; 79(5):859-66. DOI: 10.2319/062208-325.1. View

12.

Chisari J, McGorray S, Nair M, Wheeler T . Variables affecting orthodontic tooth movement with clear aligners. Am J Orthod Dentofacial Orthop. 2014; 145(4 Suppl):S82-91. DOI: 10.1016/j.ajodo.2013.10.022. View

13.

Zhang X, He L, Guo H, Tian J, Bai Y, Li S . Integrated three-dimensional digital assessment of accuracy of anterior tooth movement using clear aligners. Korean J Orthod. 2015; 45(6):275-81. PMC: 4664903. DOI: 10.4041/kjod.2015.45.6.275. View

14.

Misawa-Kageyama Y, Kageyama T, Moriyama K, Kurihara S, Yagasaki H, Deguchi T . Histomorphometric study on the effects of age on orthodontic tooth movement and alveolar bone turnover in rats. Eur J Oral Sci. 2007; 115(2):124-30. DOI: 10.1111/j.1600-0722.2007.00428.x. View

15.

Gao M, Yan X, Zhao R, Shan Y, Chen Y, Jian F . Comparison of pain perception, anxiety, and impacts on oral health-related quality of life between patients receiving clear aligners and fixed appliances during the initial stage of orthodontic treatment. Eur J Orthod. 2020; 43(3):353-359. DOI: 10.1093/ejo/cjaa037. View

16.

Long M, Wang C, Liu D . Glycated hemoglobin A1C and vitamin D and their association with diabetic retinopathy severity. Nutr Diabetes. 2017; 7(6):e281. PMC: 5519189. DOI: 10.1038/nutd.2017.30. View

17.

Martorelli M, Gerbino S, Giudice M, Ausiello P . A comparison between customized clear and removable orthodontic appliances manufactured using RP and CNC techniques. Dent Mater. 2012; 29(2):e1-10. DOI: 10.1016/j.dental.2012.10.011. View

18.

BRIDGES T, King G, Mohammed A . The effect of age on tooth movement and mineral density in the alveolar tissues of the rat. Am J Orthod Dentofacial Orthop. 1988; 93(3):245-50. DOI: 10.1016/s0889-5406(88)80010-6. View

19.

Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi C . Efficacy of clear aligners in controlling orthodontic tooth movement: a systematic review. Angle Orthod. 2014; 85(5):881-9. PMC: 8610387. DOI: 10.2319/061614-436.1. View

20.

Kong W, Ke J, Hu X, Zhang W, Li S, Feng Y . Applications of cone-beam computed tomography to assess the effects of labial crown morphologies and collum angles on torque for maxillary anterior teeth. Am J Orthod Dentofacial Orthop. 2016; 150(5):789-795. DOI: 10.1016/j.ajodo.2016.03.029. View