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Title Rotation of Canines Should Not Be Attempted With Invisalign if more than 15° of Rotation is Needed
Clinical Question For a 23 year old female with rotated canines and concerns about esthetics, would Invisalign be a better treatment option compared to traditional braces?
Clinical Bottom Line If the canines are rotated more than 15 degrees then traditional braces should be used to achieve an accurate result or combination therapy of traditional braces and Invisalign to gain desired result. Attachments may be used to try to enhance the result with Invisalign. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) N/ADurrett/2004284 teeth in patientsRandomized Controlled Trial
Key resultsMean rotation achieved with Invisalign with attachments was 5-6°.
#2) 19121497 Kravitz/200937 participants; 401 teeth totalCase Series
Key resultsP <0.05 showed canine rotations greater than 15° were less accurate than rotations less than 15°.
#3) 18302468Kravitz/200831 participants, 53 caninesClinical Study
Key resultsNo statistically significant differences between the attachment only, interproximal reduction only, and control in rotational accuracy. Accuracy of Invisalign is 35.8%. in general.
#4) N/ALagravere/200531 studiesSystematic Review
Key resultsNo definitive results can be obtained by reviewing past research, but this is the most comprehensive study with the highest level of evidence to date.
Evidence Search Pubmed: (invisalign AND canine rotation) AND (randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract]))Pubmed: "Orthodontic Appliances"[Mesh] AND "Cuspid"[Mesh] AND invisalignPubmed: "Orthodontic Appliances"[Mesh] AND invisalign Limits: systematic reviewGoogle Scholar: invisalign canine
Comments on
The Evidence
In the Kravitz (2009) article “the accuracy of rotation for the maxillary canines (32.2%) was significantly lower than that of the maxillary central incisors (54.2%) and mandibular lateral incisors (51.6%). The accuracy of rotation for the mandibular canines (29.1%) was significantly lower than that of the maxillary central, mandibular central (48.8%), and mandibular lateral (51.6%) incisors”. The 2008 Kravitz article concludes that patients are unlikely to get the desired result for canines with the first set of Invisalign aligners alone. Most of the patients had a clinically noticeable difference between the achieved tooth position and desired movement.
Applicability Applicable to any general dentist or orthodontist employing Invisalign techniques.
Specialty/Discipline (General Dentistry) (Orthodontics)
Keywords invisalign, attachments, braces, adult braces, clear braces, canine rotation
ID# 515
Date of submission: 01/13/2010spacer
E-mail cooperrb@uthscsa.edu
Author R. Bryn Cooper
Co-author(s) e-mail
Faculty mentor/Co-author John P. Hatch, PhD
Faculty mentor/Co-author e-mail hatch@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Calvin Tardy (San Antonio, TX) on 10/22/2014
A PubMed search related to this question was completed in October of 2014. The evidence presented in this CAT related to the rotation of canines through the use of Invisalign is still the most up-to-date.
by Sara T. Phillips (San Antonio, TX) on 04/15/2012
The studies presented in this CAT are the most up-to-date and highest level of evidence that answers the PICO question. No new evidence was found that addresses correction of canine rotation with the use of Invisalign.

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