How accurate is Invisalign in nonextraction cases? Are predicted tooth positions achieved?

To evaluate the accuracy of Invisalign technology in achieving predicted tooth positions with respect to tooth type and direction of tooth movement.

The posttreatment models of 30 patients who had nonextraction Invisalign treatment were digitally superimposed on their corresponding virtual treatment plan models using best-fit surface-based registration. The differences between actual treatment outcome and predicted outcome were computed and tested for statistical significance for each tooth type in mesial-distal, facial-lingual, and occlusal-gingival directions, as well as for tip, torque, and rotation. Differences larger than 0.5 mm for linear measurements and 2° for angular measurements were considered clinically relevant.

Statistically significant differences (P < .05) between predicted and achieved tooth positions were found for all teeth except maxillary lateral incisors, canines, and first premolars. In general, anterior teeth were positioned more occlusally than predicted, rotation of rounded teeth was incomplete, and movement of posterior teeth in all dimensions was not fully achieved. However, except for excess posttreatment facial crown torque of maxillary second molars, these differences were not large enough to be clinically relevant.

Although Invisalign is generally able to achieve predicted tooth positions with high accuracy in nonextraction cases, some of the actual outcomes may differ from the predicted outcomes. Knowledge of dimensions in which the final tooth position is less consistent with the predicted position enables clinicians to build necessary compensations into the virtual treatment plan.