Korean J Orthod.  2023 Jul;53(4):264-275. 10.4041/kjod22.243.

Maxillary alveolar bone evaluation following dentoalveolar expansion with clear aligners in adults: A cone-beam computed tomography study

• Figueiredo MAd
• Romano FL
• Feres MFN
• Stuani MBS
• Ferreira JTL
• Nahás ACR
• Matsumoto MAN

• KMID: 2545042
• DOI: http://doi.org/10.4041/kjod22.243

Abstract

Objective
To investigate the effects of maxillary orthodontic expansion on the alveolar bone tissue in adult patients treated with aligners by using conebeam computed tomography.
Methods
Thirty patients (22 females and 8 males; mean age: 36.3 years) were treated with Invisalign^® aligners. Conebeam computed tomography and digital models were obtained before (T0) and after (T1) upper arch expansion. The bone thicknesses in the cervical, middle, and apical areas of the incisors, canines, premolar, and first molars were buccally and palatally measured, totaling 96 areas and 2,880 measurements. The buccolingual inclinations and transverse measurements of the teeth were obtained from digital models to correlate them with the bone changes. The statistical tests used were Student’s t-test, analysis of variance, and Pearson’s correlation tests (p < 0.05).
Results
From the 96 areas evaluated, 84 revealed an increase or stability in the alveolar bone thickness and twelve displayed significant bone loss. Bone changes did not correlate with the tooth inclination and transverse measurements.
Conclusions
Within the limitation of the present study, mild levels of upper arch expansion obtained with Invisalign^® aligners in adult patients did not result in any clinically significant loss of alveolar bone thickness.

Keyword

Alveolar bone loss; Clear aligners; Cone-beam computed tomography; Periodontics

Figure

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  Figure 1 Transverse measurements: C 3 × 3 = linear measurements of the most buccal point of the cusps of teeth #13 to #23; BC 4 × 4 = linear measurement of the most buccal points of teeth #14 to #24; PC 4 × 4 = linear measurement of the most palatal point of the palatal cusps of teeth #14 to #24; BC 5 × 5 = linear measurement of the most buccal point of the buccal cusps of teeth #15 to #25; PC 5 × 5 = linear measurement of the most palatal point of the palatal cusps of teeth #15 to #25; MBC = linear measurement of the most buccal point of the linear mesiobuccal cusps of teeth #16 to #26; TMW 6 × 6 = linear measurement of the intersection between the palatal sulcus and gingival margins of teeth #16 to #26.

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  Figure 2 OnDemand 3D software (Cybermed Inc., Daejeon, Korea). A, Coronal view automatically formed by the reference lines. B, Sagittal view used to measure and determine the anterior teeth. C, Axial view with reference lines created by the software. D, Three-dimensional model created by the software.

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  Figure 3 A, Incisor positioning. B, Premolar positioning. C, Molar positioning.

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  Figure 4 Bone tissue measurements. A, Linear measurements: CEJ-BC (distance between the cementoenamel junction and buccal bone crest); CBT (cervical buccal thickness): bone tissue present in the buccal face (cervical region) at a distance of 3.0 mm from the CEJ; MBT (middle buccal thickness): bone tissue present in half of the middle third of the buccal face; ABT (apical buccal thickness): bone tissue present in half of the apical third of the buccal face; CEJ-PC (distance between cementoenamel junction and palatal bone crest); CPT (cervical palatal thickness): bone tissue present in the palatal face (cervical region) at a distance of 3.0 mm from the CEJ; MPT (middle palatal thickness): bone tissue present in half of the middle third of the palatal face; APT (apical palatal thickness): bone tissue present in half of the apical third of the palatal face. B, Linear and angular measurements.

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  Figure 5 Alveolar bone tissue of the A, first premolar; B, second premolar; C, first molar.

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  Figure 6 Long axis of the teeth based on the palatal plane (PP). A, Incisor.PP. B, Canine.PP. C, First premolar.PP. D, Second premolar.PP. E, First molar.PP. PP, palatal plane.

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