Efficiency evaluation of maxillary molar distalization using Invisalign based on palatal rugae registration

This study aimed to compare the predicted maxillary molar distalization with the achieved clinical outcome using the palatal rugae area for registration and superimposition of digital models. Understanding Invisalign efficiency may assist clinicians in predicting changes, thus applying specific measures to minimize the chance of midcourse correction later.

The study sample included 38 patients with a mean age of 25.4 years, eligible for Invisalign treatment and requiring distalization of maxillary molars. Two digital models were acquired using iTero intraoral scanner (Align Technology, Santa Clara, Calif) before treatment and after maxillary first and second molar distalization. The 2 digital models were superimposed using the palatal rugae area for registration. The predicted tooth movement compared to the achieved values. One hundred forty-two maxillary molars (71 first molar and 71 second molar) were measured for distal movement, and 228 maxillary anterior teeth were evaluated for anterior anchorage loss.

The predicted distal movement of the maxillary first molar (P <0.0001) and maxillary second molar (P <0.0001) differed significantly from the actual values. There was a statistically significant correlation between the amount of distal molar movement and the amount of anchorage loss (r = 0.3900, P <0.008) for the central incisor, and (r = 0.3595, P <0.013) for the lateral incisor.

Invisalign can be used successfully for adult patients requiring maxillary molar distalization when a mean distalization movement of 2.6 mm was prescribed. Clinicians should be aware of the countereffect if maxillary molars are planned to move distally, especially if the patient presented initially with a large overjet, so the need to prescribe overcorrection or the use of auxiliaries can be addressed earlier.