In the daily practice, the orthodontist may be confronted with particular clinical situations with one or more missing teeth. This can complicate the therapeutic plan and influence the choice of possible extractions imposed by treatment requirements. In case of permanent molar absence, making decision becomes even more delicate. The practitioner must use his/her critical sense and clinical common sense to make the right choice between closing and redeveloping the residual spaces. Its choice must meet the patient’s expectations and correct the clinical problem without risking overtreatment, or extending duration care. Several factors guide the therapeutic decision, ranging from the patient’s age to economic factors, not to mention the technical complexity, therapeutic predictability, and patient comfort, which determine proper compliance and therefore success. In this chapter, we will focus on these decision-making factors by determining the scientific evidence level in terms of success, survival, and patient-centered outcomes (quality of life and functional efficiency).
Part of the book: Human Teeth
Clear aligners, as a transparent and removable appliance, offer an alternative to conventional fixed appliance to patients with high demands for esthetics and comfort. Only a few investigations have focused on the efficacy of clear aligner therapy in controlling orthodontic tooth movement. Furthermore, the stability after treatment has not been thoroughly investigated. The purpose of this chapter was to update the knowledge of the available evidence about effectiveness and stability of clear aligners in non-growing subjects. Searches was made in different databases from January 2015 to January 2021. Relevant articles that met the inclusion criteria were selected. The level of evidence of the studies was moderate. The vertical movements of tooth were difficult to accomplish. Mesiodistal tipping showed the most predictability (82.5%) followed by vestibulolingual tipping. Molar distalization was also recorded as the highest accuracy. Derotation was difficult to accomplish with aligners especially of rounded teeth. The effectiveness of aligners in achieving the simulated transverse goals was 45%. The stability of clear aligner therapy was assessed by only two studies. Refinements are likely needed in almost all cases and to ensure treatment stability a retention period using a specific protocol is necessary.
Part of the book: Current Trends in Orthodontics