Activation time and material stiffness of sequential removable orthodontic appliances. Part 1: Ability to complete treatment

Recent advances in technology have led to the availability of sequential removable orthodontic appliances (aligners) to move teeth in a stepwise fashion (Invisalign, Align Technology, Santa Clara, Calif). This study was undertaken to compare 2 distinctly different materials (hard and soft) and 2 activation frequencies (1 week and 2 weeks) for this technique. Fifty-one subjects, stratified by peer assessment rating (PAR) and need for extractions, were randomly assigned to a hard or a soft plastic appliance, and a 1-week or 2-week activation time. The primary endpoint was the completion of the initially prescribed series of aligners. Changing aligners every other week was more likely to lead to completion of the initial series of aligners than changing aligners weekly (37% vs 21%). No substantial difference in the completion rate was observed for the soft versus the hard appliance (27% vs. 32%). The completion rate was highest (46%) among patients with PAR scores less than 15 and no planned extractions, and lowest (0%) among subjects who had 2 or more premolars extracted. All who completed their initial series of aligners; required an additional series of aligners; or fixed appliances to achieve the original treatment goals. This exploratory study suggests that subjects with a 2-week activation regimen, no extractions, and a low PAR score are more likely to complete their initial series of aligners.