New protocol for complex treatment with in-house clear aligners just as effective as fixed appliances

DAMASCUS, Syria: The use of clear aligners in mild to moderate cases of malocclusion has been the subject of numerous studies, particularly as more dentists make the decision to begin offering their own in-house aligner options. However, a team at the Damascus University dental school has conducted a trial that will add to the limited body of literature on the efficacy of in-house clear aligners versus conventional fixed appliances in more complex occlusion cases. The study found no significant difference between the results of either group and attributed the success of the aligners to a new treatment protocol designed for the study.

The randomised control trial focused on cases of Class I skeletal and dental malocclusion with severe crowding requiring orthodontic treatment and extraction of the maxillary and mandibular first premolars. The team created and implemented a treatment protocol called stepwise activated movements by multiple enhanced re-anchorage (SAMMER), which divided the movement into three stages of de-crowding, space closure and refining. The authors concluded that using the SAMMER protocol with in-house aligners allows treatment of complex cases, even those requiring premolar extraction, just as effectively as fixed appliances and with no significant difference in treatment duration.

No statistically significant differences were found between the two groups at the end of treatment, the occlusion of all patients being improved and that of more than 88% of patients in both groups being greatly improved. In comparison with a previous study which found that Invisalign aligners required a 44% longer treatment time than fixed appliances, the present study found that in-house aligners achieved the desired results 2.9 months faster than the fixed appliances. The study authors attributed this dramatic difference to the SAMMER protocol, which moves the anterior teeth gradually to resolve crowding and uses fewer aligners than Align Technology’s G6 protocol.

The study, titled “The effectiveness of in-house clear aligners and traditional fixed appliances in achieving good occlusion in complex orthodontic cases: A randomized control clinical trial”, was published online on 10 October in the Cureus Journal of Medical Science.


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