Risk Factors of Composite Attachment Loss in Orthodontic Patients during Orthodontic Clear Aligner Therapy: A Prospective Study

Abstract

Background. The composite attachment loss during orthodontic clear aligner therapy is an adverse event that commonly happens in our daily practice. However, there is a lack of related statistical analysis and studies analyzing the related risk factors. Therefore, the aim of this study is to assess the incidence of attachment loss during orthodontic clear aligner therapy and to identify rick factors that may predict such event. Materials and Methods. The demographics and clinical variables of 94 patients undergoing clear aligner therapy (27 males and 67 females; average age: 27.60 ± 0.86 years ) were recorded. Both patient-related and tooth-related attachment loss was recorded. The chi-squared test and logistic regressive analysis were applied to identify the potential risk factors. SPSS for Mac (version 23.0, IBM, USA) was used for statistical analyses. P < 0.05 was considered statistically significant. Results. Our study suggested that the risk factors for attachment loss include frequent aligner removal (≥ 5 times a day) ( losing rate = 60.0 % , P = 0.005 ), aligner wear time less than 18 hours a day ( losing rate = 50.8 % , P = 0.014 ), eating without aligners inserted ( losing rate = 47.9 % , P = 0.034 ), utilizing aligner tray seaters ( losing rate = 48.2 % , P = 0.006 ), and unilateral mastication ( losing rate = 52.1 % , P = 0.002 ). The multivariable logistic regression analysis indicates that aligner wear time less than 18 hours a day ( P = 0.020 , B = 0.925 ), using aligner tray seaters ( P = 0.007 , B = 1.168 ), and unilateral mastication ( P = 0.034 , B = − 0.458 ) were considered independent factors that can predict the composite attachment loss in orthodontic clear aligner therapy. Conclusion. Wearing aligner less than 18 hours a day, using aligner tray seaters, and unilateral mastication may contribute to increased incidence of composite attachment loss during orthodontic clear aligner therapy.

Invisalign® vs. Spark™ Template: Which Is the Most Effective in the Attachment Bonding Procedure? A Randomized Controlled Trial

“…Over the years, the use of clear aligners systems for orthodontic treatment has become increasingly frequent because of the indisputable advantages they offered, such as aesthetic, ease of use, comfort for the patient, ease in oral hygiene maintenance, and possibility to manage a variety of different malocclusions [4,11,12].…”

“…In order to satisfy these requirements, various companies have started to produce and introduce in the orthodontic market the so-called clear aligners [1]. As early as 1946, Kesling introduced the possibility to consecutively use a series of thermoplastic tooth positioners to progressively reposition misaligned teeth [2,3]; but one of the pioneers in this panorama was Align Technology Inc. (Santa Clara, CA, USA), who in the late 1990s, introduced orthodontic treatments with clear aligners using sequential application of clear alignment devices made from thermoplastic material [2][3][4][5][6]. This system is called Invisalign ® .…”

“…One of the bases of the orthodontic therapy with clear aligners are the attachments that are composite resin buttons, which can be applied to the vestibular or lingual surfaces of the teeth, required as retention elements and/or to improve the efficiency of dental movements, especially if complex [4][5][6][7]. Therefore, they constitute fundamental mechanical components as they allow to transfer the determined forces from the aligner to the tooth root and crown for generating efficient tooth movement [4]. For these reasons, they have to remain intact for the entire duration of the treatment.…”

The Impact of Orthodontic Treatment on Masticatory Performance: A Literature Review

“…Studies investigating the extent to which adults [ 7 , 9 ] and adolescents [ 6 , 8 ] perceive the need to undergo orthodontic treatment and the extent to which this perception reflects the actual reality of the situation showed that the younger generation has been esthetically more concerned with their oral health and is giving greater attention to the condition of their occlusion. Cultural influence has been reported to be the main force of such a decision [ 6 ], followed by the need to improve chewing performance, with the latter being valued mainly post-treatment [ 10 , 58 ].…”

“…There are several factors that impact the effectiveness of orthodontic devices used during the treatment [ 57 , 58 ]. Studies have shown that chewing does not have a significant effect on the effectiveness of orthodontic devices over time but rather on the intraoral environment [ 57 ].…”