A Longitudinal Study of the Effects of Invisalign Treatment on Upper Pharyngeal Airway Dimensions in Adults with Class II Malocclusion: A CBCT Pilot Study
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Purpose: To evaluate the post-treatment effects of Invisalign aligners on the dimensions of the upper pharyngeal airway and to assess the effects of Invisalign treatment on daytime sleepiness, in a population of class II adult patients. Materials and Methods: A prospective cohort study was completed. Inclusion criteria were healthy females and males over the age of 18 years, Angle Class II malocclusion, first molar relationship of end-to-end or greater, full permanent dentition from molar to molar, overjet < 10mm, and presenting for non-surgical non-extraction comprehensive orthodontic treatment in both arches with the Invisalign appliance. Treatment mechanics for class II correction included class II elastics only without maxillary sequential distalization programmed into aligners. Treatment changes were evaluated based on upper airway analyses of pre and post-treatment CBCT scans using the Dolphin 3D module. Dentoskeletal treatment changes were evaluated based on pre and post-treatment lateral cephalograms constructed from the CBCT scans. The treatment effect on daytime sleepiness was evaluated using an Epworth Sleepiness Scale (ESS) completed pre and post-treatment. Results: Eight subjects were included in the study. The mean age of patients at treatment initiation was 44.6 years (SD = 15.3). (Table 4) The mean treatment duration was 12.2 months (SD = 3.4) with a mean of 81.4 aligners for both the upper and lower arches (SD = 30.6). No statistically significant treatment changes were observed in upper airway dimensions and morphology, cephalometric analysis, or ESS questionnaires. Conclusion: This study concluded that treatment of a class II malocclusion in non-growing patients using the Invisalign appliance has no statistically significant effects on the airway morphology, skeletal or dental characteristics, or daytime sleepiness. Future studies with larger samples are warranted.