Accuracy of clear aligners: A retrospective study of patients who needed refinement

Introduction: The purpose of this study was to determine the accuracy of specific tooth movements with Invisalign (Align Technology, Santa Clara, Calif). Methods: The study sample included 20 Class I adult patients treated with Invisalign; they completed their first series of aligners and had to have a refinement series. Initial and predicted models were obtained from the initial ClinCheck (Align Technology). The starting point of the refinement ClinCheck was used to create the achieved models. Predicted and achieved models were superimposed over the initial ones on posterior teeth using the 3-dimensional Image Analysis open-source software Slicer CMF. Three hundred ninety-eight teeth were measured for vertical, horizontal, and rotational movements, and transverse widths were measured. The amount of predicted tooth movement was compared with the achieved amount for each movement. Results: Horizontal movements of all incisors seemed to be accurate, with small (0.20-0.25 mm) or insignificant differences between predicted and achieved amounts. Vertical movements and particularly intrusions of maxillary central incisors were found to be less accurate, with a median difference of 1.5 mm (P <0.001). All achieved rotations were significantly smaller than those predicted, with the maxillary canines exhibiting the greatest difference of 3.05 degrees (P <0.001). Conclusions: The most inaccurate movements identified in this study were intrusion of the incisors and rotation of the canines.