An increasing number of late adolescent and adult patients are seeking invisible orthodontic care to correct mild to moderate anterior malocclusions. Since 2000, Invisalign has been the treatment alternative for patients seeking invisible orthodontics for minor tooth correction. Recently, there has been growing interest by orthodontists in alternative methods of invisible orthodontics.
Simpli5 is a series of five sequential orthodontic aligners for correction of minor to moderate anterior malocclusions. Introduced in 2006, Simpli5 was an elaboration of AOA Orthodontic Laboratory’s previously available three-aligner system, Red White & Blue. The additionaltwo aligners allow for greater case complexity and improved finishing.
The DuraClear aligners are made of 0.030 inch polyurethane vacuformed over a stone model setup. Each aligner programs up to 0.5 mm of tooth movement, allowing for up to 2.5 mm of movement per arch.
Clinical indications for Simpli5
The ideal candidates for Simpli5 treatment are non-growing patients with Class I malocclusion with minor or moderate anterior crowding or spacing, or who have experienced minor orthodontic relapse. Simpli5 is appropriate for the following conditions:
- crowding or spacing of 2.5 mm or less;
- midline correction of 2 mm or less; and
- rotations of 10 degrees or less.
Clinical studies have shown that the least predictable tooth movements with removable aligners are incisor extrusion, canine/premolar rotation and root uprighting.1,2 Therefore, even a Class I malocclusion that requires extrusion of the maxillary lateral incisors, canine rotation or bodily tooth movement to close a large diastema may be less suitable for removable orthodontic aligners and more appropriate for anterior lingual braces.
- Call AOA Orthodontic Laboratory to ask for a Simpli5 starter kit, which includes case selection examples and patient education pamphlets, prepaid mail packaging and prescription forms.
- Take upper and lower polyvinyl siloxane (PVS) impressions with bite registration. I prefer to use an Aquasil Easy Mix Putty base lined with Aquasil Ultra XLV (extra low viscosity) Fast-Set liner (DENTSPLY International, York, Pa.).
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- Fill out the Simpl5 prescription form, which also is available online at www.aoalab.com. Select which teeth to reset, which teeth to reproximate or whether to leave space for future restorations. Due to the limited number of aligners, clinicians should be conservative with reproximation. For more difficult cases or for highly demanding patients, clinicians also can choose to receive a final diagnostic setup via express service to review with the patient.
Similar to Invisalign, football-shaped tooth attachments, or DuraClasps — invisible clasping insets — can be selected for greater tray retention. I do not recommend placing attachments on upper incisors as many patients find attachments bulky and unsightly. For malrotated canines, the clinician may consider placing both buccal and lingual attachments or request for slight overcorrection.
Lastly, I do not recommend placing attachments if the patient intends on bleaching during treatme
nt (by using the aligner as a bleaching tray) as the composite buttons result in unbleached circles around the tooth.
Treatment with Simpli5
Included in the Simpli5 package are the five aligners sealed in individualized plastic bags and separated according to arch, along with the reproximation form.
When seating the first aligner, I encourage patients to bite edge-on to ensure full seating. Attachments should be placed at the first appointment using aligner one — there is no separate aligner for placing attachments. Finally, I choose to perform all reproximation at the second aligner visit and never at the first appointment, which should be an enjoyable experience for the patient.
Each aligner is worn 22 hours a day for one to three weeks, resulting in treatment duration of 10 to 20 weeks. AOA Laboratory literature suggests that check-up evaluations may be as infrequent as six to eight weeks, with the patient given the subsequent aligners to change on his or her own.
In my office, we give one aligner per office visit, with each aligner to be worn for a minimum of three weeks. Patients may assume a certain amount of chair time to justify the cost of treatment, which without may cause frustration despite achieving high quality results.
At each visit, reinforce patient compliance and check for aligner lag space between the aligner and the tooth, an indication of poor tooth tracking. If lag is occurring, confirm patient compliance and even consider removing tooth attachments to aid aligner seating.
Instruct the patient to wear his or her current aligner for an additional three weeks or step back into the previous aligner. At the completion of treatment, I retain patients in a bonded U2112 and L321123 gold chain; however, the durable, crystal-clear aligners make for adequate retainers.
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Dr. Neal D. Kravitz may be contacted at firstname.lastname@example.org.