Rapid City Invisalign

Invisalign is the product of Align Technology Inc. The company was founded in 1997 by Zia Chishti and Kelsey Wirth. The author of this article started working with Align Technology in 1998 after completing a three year orthodontic residency at UCSF. Presented here are two cases that were treated with Invisalign. One of which is a lower interproximal reduction case and the other a lower incisor extraction case. The reader should keep in mind that both of these patients were treated in a small clinical trial conducted by the author and funded by Align Technology. The author does have proprietary interest in Align Technology.

Nov. 30, 2000 — Forget the gunmetal-gray strapping — it’s not the only way to get straight teeth. That’s essentially the marketing pitch behind a new type of orthodontic device that promises a straight smile while being easy on the eyes.

The Invisalign process uses a series of clear, plastic molds to gradually move the teeth. They’re kept in place 24-hours a day — except for when brushing, flossing, and eating — and changed out every two to three weeks as the teeth straighten. The shape of the molds — and hence the final position of the straightened teeth — is determined by creating a three-dimensional movie of each patient’s mouth. It simulates, from beginning to end, the stages the teeth will go through as they’re adjusted.

The manufacturer of the system, Align Technology, Incorporated, of Sunnyvale, Calif., says the molds offer a more efficient way of straightening teeth, because at different stages in the process, only the teeth that need to be moved are moved. Still, that saves no time.

And there’s something else: Children can’t use them. The company says its computer imaging technology doesn’t work for growing teeth.

So where’s the market? Right here: Twenty or 30 years ago we weren’t treating too many adults, says Michael Rennert, , an orthodontist in Montreal and president of the American Association of Orthodontists. Today, I would say the average orthodontist in an urban practice probably has 20-30% of the practice in adults. That’s compared to about 5% in the past, he says. Rennert a the new adult market has money and is concerned with both how the mouth looks and works. But not all of them can use the Invisalign system. It is certainly something that has a place in every orthodontist’s armamentarium … for select, minor adult cases.

Which does not necessarily mean the other adult cases have to stuff tire chains into their mouths. Rennert says today’s conventional braces are smaller and less conspicuous — and even work better than the old clunkers. The wire is still there, but the [newer] appliances are much more comfortable, he says. The traditional metal brace can be replaced by clear braces and braces from behind.

But hold on. Robert L. Boyd, , chairman of the department of orthodontics at the University of the Pacific in San Francisco, says that even with more complicated cases, he has seen good results with Invisalign. There’s no doubt it will take its place as one of the methods to straighten your teeth, he says. On simple cases, it worked quite well. With moderate to moderate-difficult cases — those needing the equivalent of one year of treatment with braces — it worked very well. And that represents 40-50% of the market. Boyd, who conducted studies of Invisalign, says that in three short years, about half the orthodontists in the U.S. have learned to use the system — and patient demand is high.

Cost is not as much of an issue because it’s less doctor time. So we’re charging 20% to 25-30% more than conventional braces. Boyd says in his neck of the woods, few patients worry about the extra cost.

But that may not be the case elsewhere. The fees are high, says Elidio Deleon, DMD, chair of the department of orthodontics at the Medical College of Georgia in Augusta. Let’s say basic braces are $3,000. If you want Invisalign, there’s $500 for the set-up then ‘X’ number of dollars for each retainer. If you’re in an area like California, where it’s more affluent, then patients are certainly willing to give it a try. In our area, an excess of money is just not available. Money is a driving force.

Furthermore, that money could be wasted if patients aren’t compliant, Deleon says. This appliance is totally dependent on whether the patient chooses to wear it. Yet to be determined is whether Invisalign can also move teeth in complex cases — such as when a pulled tooth has created a large space or if there is excessive crowding.

Still, there’s no doubt that Invisalign has created a buzz — even in lower-income areas. People believe that a smile is critically important to their success and they’re really jumping on it, Deleon says. A lot of people are calling here about it. But, he a, for every ten that do, just one has a mouth that might benefit.

Invisalign vs. Braces

Another option for the vain at heart is Invisalign. Patients wear a series of clear, removable orthodontic aligners that are adjusted as the teeth shift into place without metal or wires. A series of custom-made aligners are worn each for a period of two weeks. Each aligner moves the teeth progressively into place. Average total treatment time: a few months to 1 1/2 years. While orthodontists say Invisalign can be a good alternative to traditional braces, there are limitations.

Invisalign does not do a great job on vertical problems, where the teeth are at different heights, teeth are lower or higher than others. It doesn’t not do a good job on teeth that are severely rotated, and it does not do a good job at correcting bite issues, says Sebastian, who also says Invisalign would also not be the best option for fixing severely overcrowded teeth.

Sebastian says Invisalign can cost an average of $500 more than a one-year treatment with traditional braces.

Case Study

Invisible Braces:
The Orthodontics Industry Goes Wireless

A new high-profile start-up company, Align Technology, says its 3D computer imaging and manufacturing systems are key to straightening adult teeth without uncomfortable metal braces. Their system, called Invisalign (www.invisalign.com), utilizes 3D scanning hardware, automatic surfacing software, 3D animation programs, and rapid manufacturing systems –powered in part by Geomagic technology –to produce customized, removable, clear plastic appliances called aligners. Combined with an orthodontist’s treatment plan, these retainerlike aligners provide an innovative alternative to traditional braces.

Align Technology will make history as the first company to lead the wave of mass customization in the 21st century. — Ping Fu, President and CEO, Raindrop Geomagic

How Invisalign Rapid City SD Works

• Step 1
  The patient meets with an Invisalign-certified orthodontist who takes an impression and x-rays of the patient’s teeth, prescribes a treatment plan, and sends the impression to the Align Technology lab.
• Step 2
  At Align’s lab, a physical model is cast from the patient’s impression. That model is then digitized using a 3D scanner. Next, the data is imported into the Invisalign computer system, where it’s used to produce precise, manufacturable digital models and start-to-finish 3D animations of the patient’s personal treatment plan.
• Step 3
  The orthodontist reviews the 3D models and animations and approves the treatment plan. From these images, Align Technology manufactures a unique set of clear, plastic aligners that are custom-fitted to the patient’s teeth and mouth.
• Step 4
  The patient wears each stage of aligners for approximately two weeks before switching to the next in the series. Week by week, the patient’s teeth are straightened, millimeter by millimeter. Total treatment time is similar to traditional braces and usually ranges from six to 24 months depending on the complexity of the case. A single patient’s treatment series may contain up to 60 pairs of upper and lower aligners.
  Our rapid design and manufacturing processes require automation, throughput, and customization — all of which Geomagic has the unique ability to provide. — Zia Chishti, CEO, Align Technology
  The Invisalign system has received FDA clearance, meeting all medical device specifications. Raindrop Geomagic’s patented technology and engineering services enable Align to optimize its manufacturing process to meet current demand and increase capacity in the future.
  Imagine viewing a 3D animation of the next two years of changes to your daughter’s teeth — the day after her first visit to the orthodontist. — From Raindrop Geomagic’s first corporate brochure, 1997

About Invisalign and Align Technology, Inc

Align Technology, Inc., headquartered in Santa Clara, California, was founded in March 1997 to develop a next-generation, aesthetic orthodontic product.

Invisalign, Align’s core product, combines proven orthodontic science with 3-D computer graphics and mass customization technology. Invisalign has two primary components: ClinCheck and Aligners. ClinCheck is the Internet-based application that allows orthodontists to simulate treatment in 3-D by modeling stages of tooth movement. Aligners are thin, nearly invisible, removable dental appliances that correspond to each stage of the ClinCheck simulation and are used to straighten teeth. Because it does not rely on metal or ceramic brackets and wires, Invisalign offers doctors and patients an aesthetic and comfortable alternative to traditional braces.

To date, Align has received two industry awards for its design and production of Invisalign – the 2002 Medical Design Excellence Award and the 2001 Stereolithography Excellence Award. The technology behind Invisalign is cutting-edge, but the idea of using a series of appliances to move teeth is not new to orthodontics. In 1945, Dr. Kesling first described the concept of moving teeth using a series of planned, individual stages. He realized that the lab requirements would be significant, and could not envision a practical way to make the idea a reality. Kesling did have the foresight to state that technology would one day be available to make such treatment possible.

Today, Align is one of the largest manufacturers of mass customized products in the world. More than 100,000 patients have entered treatment with Invisalign, and more than five million unique Aligners have been produced.

Clinical Studies

Align Technology conducted a number of private and university-based clinical studies across the U.S. prior to commercially releasing Invisalign. Align has launched new clinical studies to expand applicability and determine specific Aligner properties. As a result of these clinical studies, the range of applicability demonstrated by Invisalign has expanded significantly. A sample of on-going studies is listed below. (last updated 09/17/03)

University Based Studies

University of the Pacific School of Dentistry – Align is working with the University of Pacific to study a range of mild to severe malocclusions including bicuspid extractions, anterior open bites, and severe rotations. As a result, one article has already been published in the December 2001 issue of Seminars in Orthodontics titled, Three-dimensional diagnosis and orthodontic treatment of complex malocclusions with the Invisalign appliance.

University of Washington – Align is working with the University of Washington to conduct a randomized clinical trial to study the effectiveness of different materials and different treatment times for Invisalign. An abstract on the frequency of activation and stiffness of Invisalign Appliances was presented at the 2003 AADR/IADR meeting.

University of Florida – Align is working with the University of Florida to conduct a randomized clinical trial to study various attachment designs for extrusion, rotation, and intrusion of teeth to be used with the Invisalign appliance. A secondary goal of the study is to obtain descriptive data regarding the incidence of side-effects such as caries incidence, gingival inflammation, root resorption, and temporomandibular joint changes, associated with wearing ALIGN appliances. An abstract on the effect of Invisalign Aligners on periodontal tissues was presented at the 2003 AADR/IADR meeting.

University of Ferrara, Italy – Align is conducting a randomized clinical trial with the University of Ferrara to study the effectiveness of using an aligner material, Exceed 40 (EX40) in the Invisalign treatment process and its prevalence on case refinements and mid-course corrections. Descriptive data related to potential risk factors associated with wearing Ex40 on oral hygiene, tooth sensitivity, root resorption, and temporamandibular joint discomfort will be examined.

Tel Aviv University – Align is conducting a clinical trial at Tel Aviv University to measure strain changes over time in Aligners as they are worn and determine the forces produced by these strains, and then correlate the strains and forces with the movements and speeds programmed into the appliance.

Private Practice Studies

Bicuspid Extraction Combination Study – Align is working with an Orthodontist to conduct a randomized clinical trial to evaluate the outcome of treating bicuspid extraction cases using Invisalign in combination with braces.

Adolescent Study – Align is working with a number of doctors to conduct a randomized clinical trial to evaluate the outcome of treating Class I crowding and spacing malocclusions in adolescent patients, aged 12-18, using Invisalign.

Case Refinement Study – Align is working with a couple of orthodontists to evaluate the use of a thicker material at the end of treatment and the use of automated overcorrection to reduce case refinement. A secondary goal of this study is to obtain data regarding the types of tooth positions that require overcorrection and the amount of overcorrection required to achieve the results shown at the final stage on Clincheck.

Virtual vs. Actual Treatment Study – Align is conducting a preliminary case study with an orthodontist on the comparison of Invisalign’s virtual treatment to that of actual treatment results at every Aligner stage. The goals will be to measure teeth location differences between the virtual and real representations and analyze tooth dynamics throughout the treatment.

New Attachment Study – Align is working with a number of doctors to conduct a clinical trial to evaluate a new attachment concept and design for extrusions of incisors, canines, and premolars, and rotations of canines and premolars.

The Invisalign System: Case Report of a Patient With Deep Bite, Upper Incisor Flaring, and Severe Curve of Spee
By Dr. Ross J. Miller and Dr. Mitra Derakhshan
Seminars in Orthodontics, March 2002

This article is a case presentation for a 46-year-old man with the chief complaint of upper spacing. The treatment objectives were to close all upper spaces and reduce the overjet by retroclining and retracting upper incisors. Intruding lower incisors would level the curve of Spee and thus decrease overbite. Lower crowding was to be resolved by proclination and interproximal reduction, if needed. The buccal occlusion and Class I were to be maintained. This article addresses the treatment progress and results. Facial and intraoral photographs, as well as radiographs are included in this eight-page article.