Objectives: Qualitative research is a standard research method in social sciences. It elicits the opinions of studied individuals to understand the issues to be solved. Findings commonly lead to hypotheses for subsequent studies. In medicine, it has been utilized only sporadically despite arguments to understand quality of life of patients. We applied the phenomenological qualitative research method to understand the thought process of distinguished Invisalign practitioners. In the absence of experimental evidence, clinicians typically rely on their past clinical experience, opinions of experts, and limited published case studies. In an effort to develop a more robust knowledge base to build clinician skills, this study was designed to assess how expert clinicians address the divergence between ClinCheck® simulation and actual tooth movements with Invisalign. Methods: Structured, open-ended interviews were conducted with five orthodontists who are known Invisalign experts of complex cases. Information were collected on: their approach to difficult transverse, vertical, and extraction treatment. Interviews utilized the conventional qualitative research protocol of recording, and then transcribing to analyze the data. Results: Some experts seek to push the limits of the aligner appliance whereas others still rely upon auxiliaries, such as fixed appliances, to achieve the treatment goals. In extraction treatment, the difficulty of tipping and root paralleling were counteracted by designing ClinCheck with virtual Tweed mechanics, where the plastic and attachments create “couple” type forces. Constricted arches receive expansion of ≤3mm, coupled with flattening of curve of Wilson by buccal root torque of approximately 5-10o. Open-bite treatment relies upon intrusion of molars and “relative” extrusion of incisors whereas, deep-bite receives overcorrection with premolar extrusion to level the curve of Spee. Conclusions: The expert orthodontist’s faith in Invisalign attachments, over-correction, and efficacy of virtual mechanics in ClinCheck are influenced by the malocclusion and their previous experience. Some experts seek to push the limits by re-configuring mechanics of the aligner appliance while others rely upon auxiliaries and braces to improve predictability. Hypothesis-driven experimental studies may now be designed. / Oral Biology

INTRODUCTION: Alors qu’il existe aujourd'hui différents genres de traitements orthodontiques esthétiquement acceptables, les patients s'inquiètent maintenant de la durée des traitements. L'appareil AcceleDent® a été introduit sur le marché par OrthoAccel Technologies en 2009. Ce dispositif, placé entre les dents pendant 20 minutes par jour, vibre à une fréquence de 30 Hz et est préconisé pour accélérer le traitement. L’objectif primaire est d’évaluer la précision de la simulation ClinCheck® par rapport aux résultats finaux réels pour les deux groupes. L’objectif secondaire est de déterminer si le résultat final est influencé par une progression plus rapide des gouttières d’alignement. MATÉRIELS & MÉTHODES: Une étude rétrospective qui comprend 38 patients traités avec la technique Invisalign®. Le groupe expérimental, c’est-à-dire celui qui utilise l’AcceleDent®, comprend 13 patients tandis que le groupe contrôle inclut 25 patients. La sévérité de la malocclusion a été quantifiée avec le «Discrepancy Index de l’ABO». Concernant la prédiction des résultats de la simulation ClinCheck® et le résultat du traitement final, l’«Objective Grading System de l’ABO » a été utilisé pour quantifier ces derniers. Toutes les données ont été prises à partir du logiciel OrthoCAD (Cadent, Fairview, NJ). RÉSULTATS ET DISCUSSION: Il n'y a pas de différence statistiquement significative entre la malocclusion des 2 groupes. (p=0,761). Pour les résultats finaux, il existe une différence statistiquement significative. L'alignement est meilleur dans le groupe contrôle (p=0,002). Au sein de chaque groupe, la différence entre les résultats prédits et réels n’est pas statistiquement significative (p=0,056). L’utilisation de l’AcceleDent® semble donner un surplomb horizontal plus proche de celui prédit, cependant ceci n’est pas cliniquement significatif. CONCLUSION: L’utilisation de l’appareil AcceleDent® combiné à une progression plus rapide des coquilles aux sept jours influence négativement l’alignement final chez les patients traités par la technique Invisalign®. / INTRODUCTION: While there are presently many different options for aesthetic orthodontic treatment, patients are now concerned with the length of treatment. The AcceleDent® device was introduced by OrthoAccel Technologies in 2009. This device is placed between the teeth for 20 minutes a day, vibrates at a frequency of 30 Hz and is recommended to accelerate orthodontic treatment. This study’s primary objective is to evaluate the accuracy of the ClinCheck® simulation versus the actual final results. The secondary objective is to determine if the end result is influenced by the increased rate of treatment progression with the aligners. MATERIALS AND METHODS: A retrospective study design was used with 38 patients treated with Invisalign®. The experimental group consisted of 13 patients, while the control group included 25 patients. The severity of malocclusion was quantified with the Discrepancy Index approved by the American Board of Orthodontics. In addition, the ABO’s Objective Grading System was used to compare the prediction of the final result provided by the ClinCheck® simulation and the actual final treatment result. All data were taken from the OrthoCAD software (Cadent, Fairview, NJ). RESULTS AND DISCUSSION: There is no statistically significant difference between the two groups regarding their initial malocclusion (p= 0.761). For the final results, there is a statistically significant difference. The alignment is better in the control group (p = 0.002). Within each group, the difference between the predicted and the actual results are not statistically significant (p = 0.056). The use of AcceleDent® seems to give an overjet similar to that which was predicted; however, this finding is not clinically significant. CONCLUSION: The use of the AcceleDent® combined with changing aligners every seven days negatively influence the final alignment in patients treated with Invisalign®.