Is maxillary arch expansion with Invisalign(R) efficient and predictable? A systematic review.

BACKGROUND: The main objective of this review is to assess the effectiveness and predictability of the transverse expansion movement performed by Invisalign(R). The secondary objectives are to determine whether the expansion is of a dentoalveolar or skeletal nature, and to locate the areas of expansion on the dental arch. METHODS: Two investigators used the PubMed database to search for articles related to the subject. After using a research equation, specific inclusion and exclusion criteria were applied and the final selection of articles was done after being read in full. The ROBINS-I tool for non-randomized studies was applied to assess risk of bias in the results of each included study. RESULTS: After reading the articles in full, 12 articles were included. Regarding effectiveness, most studies showed an increase in all measured interdental distances, with a maximum expansion at the premolar level. As for predictability, significant differences were found between post-treatment models and Clincheck(R) models, making it generally weak. Concerning the nature and areas of expansion, increase of arch width was due to buccal tipping of the crowns following a decreasing gradient from anterior to posterior. CONCLUSIONS: Invisalign(R) treatment is effective in achieving a maxillary transverse expansion. However, this expansion is mainly dentoalveolar, with a facial crown tipping of the posterior teeth. Clincheck(R) software tends to overestimate the expansion movement when compared to the clinical outcome, therefore the predictability of movement is low.