Abstract

摘要

Clear aligner treatment is a novel technique in current orthodontic practice. Distinct from traditional fixed orthodontic appliances, clear aligners have different material features and biomechanical characteristics and treatment efficiencies, presenting new clinical challenges. Therefore, a comprehensive and systematic description of the key clinical aspects of clear aligner treatment is essential to enhance treatment efficacy and facilitate the advancement and wide adoption of this new technique.

透明牙套治疗是当前正畸实践中的一项新技术。与传统的固定正畸矫治器不同，透明牙套具有不同的材料特性、生物力学特征和治疗效率，带来了新的临床挑战。因此，对透明牙套治疗的关键临床方面进行全面而系统的描述，对于提高治疗效果、促进这一新技术的发展和广泛应用至关重要。

This expert consensus discusses case selection and grading of treatment difficulty, principle of clear aligner therapy, clinical procedures and potential complications, which are crucial to the clinical success of clear aligner treatment..

本专家共识就无托槽隐形矫治的病例选择与治疗难度分级、矫治原则、临床操作步骤及可能存在的并发症等影响无托槽隐形矫治临床成功的关键问题进行了阐述。

Introduction

介绍

Malocclusion is a common oral disease with the estimated prevalence among general population ranging from 43.5% to 67.2%.

错颌畸形是一种常见的口腔疾病，在普通人群中的估计患病率从43.5%到67.2%不等。

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It is associated with the risk of various oral dysfunctions and esthetic concerns, which may have detrimental effects on mental health and the quality of life.

它与各种口腔功能障碍和美观问题的风险相关，可能对心理健康和生活质量产生不利影响。

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Recent years have witnessed the growing popularity of clear aligners among patients owing to their esthetic appeal, comfort, and convenience in oral hygiene maintenance.

近年来，由于透明矫治器的美观性、舒适性和在口腔卫生维护方面的便利性，其在患者中的受欢迎程度不断提高。

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However, as a novel technology distinct from traditional fixed orthodontic appliances, clear aligner treatment (CAT) presents new challenges in case selection, treatment strategy, aligner design, and follow-up monitoring, which are associated with the differences in material characteristics and properties, and treatment outcomes..

然而，作为一种不同于传统固定矫治器的新型技术，透明矫治器治疗（CAT）在病例选择、治疗策略、矫治器设计和后续监测方面带来了新的挑战，这些挑战与材料特性和属性的差异以及治疗结果相关。

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Therefore, key clinical aspects of CAT are demanded to help improve treatment efficacy and promote continued development and dissemination of this clinical technique.

因此，需要CAT的关键临床方面来帮助提高治疗效果，并促进该临床技术的持续发展和传播。

Clear aligners are removable orthodontic appliances that were first introduced two decades ago and have been used to treat nearly 20 million patients worldwide. Since their launch, significant innovations have been achieved in the development of clear-aligned materials. The use of big data analyses and design software has enabled the aligners to tightly envelope the tooth surface and apply gentle continuous force which can be designed based on the desired tooth-specific movement direction and distance.

透明矫治器是一种可拆卸的正畸装置，于二十年前首次推出，已在全球范围内用于治疗近2000万名患者。自问世以来，透明矫治材料的开发取得了显著的创新。大数据分析和设计软件的使用使得矫治器能够紧密贴合牙齿表面，并施加温和的持续力量，这种力量可以根据预期的特定牙齿移动方向和距离进行设计。

The optimal sequence of tooth movement can be calculated precisely to ensure that tooth moves in the desired direction..

可以精确计算出牙齿移动的最佳顺序，以确保牙齿朝着理想的方向移动。

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Furthermore, clinical solutions have evolved from optimizing individual to optimizing group teeth movement, while clinical indications have expanded from simple to complex cases, including surgical cases.

此外，临床解决方案已从优化单个牙齿移动发展到优化群体牙齿移动，而临床适应症已从简单病例扩展到复杂病例，包括手术病例。

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Consequently, CAT has become the primary innovating trend in orthodontics.

因此，CAT已经成为正畸学的主要创新趋势。

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To date, over 5000 publications on clear aligners have been indexed on PubMed, including case reports, clinical trials, retrospective clinical studies, and reviews, highlighting the on-going interest in this field.

迄今为止，PubMed上已索引了5000多篇关于透明矫治器的出版物，包括病例报告、临床试验、回顾性临床研究和综述，突显了该领域持续的研究兴趣。

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The purpose of this expert consensus was to summarize the core technology of CAT and provide clinical guidance for practitioners in terms of indications, treatment strategies, aligner design, and follow-up monitoring.

本专家共识的目的是总结CAT的核心技术，并在适应症、治疗策略、矫治器设计及随访监控方面为临床从业者提供指导。

Case selection and grading of treatment difficulty

病例选择与治疗难度分级

Indications and contraindications

适应症与禁忌症

The current indications for CAT are comparable to those for fixed orthodontics. Clear aligners can be used to treat nearly all types of malocclusions, especially the patients with high esthetic and comfort requirements, poor periodontal conditions, susceptibility to caries, or enamel developmental defects.

CAT的适应症与固定矫治器相似。透明矫治器可用于治疗几乎所有的错牙合类型，尤其是那些对美观和舒适度要求高、牙周状况差、易患龋齿或釉质发育缺陷的患者。

However, clear aligners are not recommended for patients with clinically short crowns, requiring extensive mesial movement of the posterior teeth, or showing poor compliance..

然而，对于临床牙冠短、需要后牙广泛近中移动或依从性差的患者，不建议使用透明矫治器。

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However, treatment difficulty of clear aligner therapy varies greatly among cases. Thus, we suggest difficulty-grading criteria for CAT.

然而，透明矫治器治疗的难度在不同病例之间差异很大。因此，我们建议对CAT进行难度分级。

Grading of treatment difficulty

治疗难度分级

Clear aligners are made of elastic materials, and teeth are moved by the rebound force generated by the elastic deformations of the aligner materials when the aligners are positioned.

透明矫治器由弹性材料制成，当矫治器就位时，通过矫治器材料的弹性变形产生的回弹力来移动牙齿。

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Thus, aligners mainly provide a “pushing force”, and their clinical efficiency varies among different types of tooth movements (Fig.

因此，对齐器主要提供“推力”，其临床效率因不同类型的牙齿移动而异（图。

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Therefore, it is crucial to accurately assess treatment difficulty and select most suitable cases.

因此，准确评估治疗难度并选择最合适的病例至关重要。

Fig. 1

图1

Predictability of different tooth movements achieved through clear aligner therapy

通过透明矫正器治疗实现的不同牙齿移动的可预测性

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We developed the CAT-CAT difficulty assessment tool,

我们开发了CAT-CAT难度评估工具，

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which assigns scores based on model analysis, X-ray examination results, and clinical examination results. According to the literature and authors’ clinical experience, clinical cases were divided into four grades: easy, moderate, difficult and challenging (Table

该评分系统基于模型分析、X光检查结果和临床检查结果进行评分。根据文献和作者的临床经验，临床病例被分为四个等级：简单、中等、困难和极具挑战性（表

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Table 1 Grading of clear aligner treatment difficulty

表格1：透明矫正器治疗难度分级

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Owing to the biomechanical differences between CAT and traditional fixed orthodontics, it is imperative for clinicians to fully understand the characteristics of CAT and gradually implement treatment based on the difficulty level in each case to help minimize the associated risks.

由于CAT与传统固定矫治器的生物力学差异，临床医生必须充分了解CAT的特点，并根据每个病例的难度逐步实施治疗，以帮助将相关风险降至最低。

Principles of clear aligner therapy

隐形矫治器治疗的原则

Different from traditional fixed orthodontic appliances, clear aligners are made of elastic materials, which cover the whole or partial clinical crowns and create a “pushing” force produced from material deformation of the clear aligners. Thus, theoretically, the force can be designed to exert onto any part of the tooth crowns as long as it is closely covered by the aligners.

不同于传统的固定矫治器，透明矫治器由弹性材料制成，覆盖整个或部分临床牙冠，并通过透明矫治器的材料变形产生“推动”力。因此，理论上，只要牙齿被矫治器紧密覆盖，力量可以设计作用于牙冠的任何部位。

Thus, the crowns’ surface area and the fitness of the aligners are the key points to the success of treatment. Attachments used in clear aligner treatment are bonded on the crowns, which can not only increase the surface area but also afford more action points of the force. Attachments in various shapes and sizes can be designed to supplement clear aligners for different biomechanical demands..

因此，牙冠的表面积和矫治器的适配性是治疗成功的关键。透明矫治器治疗中使用的附件粘接在牙冠上，不仅能够增加表面积，还能提供更多的着力点。可以设计不同形状和大小的附件，以满足透明矫治器在不同生物力学需求下的补充作用。

Besides, as we know, several types of arch wires made from different materials and in different shapes and/or sizes are used in traditional fixed treatment. In general, arch wires are used from thin to thick, round to rectangular, Niti to stainless steel, and therefore soft and flexible to solid and stable during the treatment.

此外，众所周知，在传统的固定治疗中会使用由不同材料制成、形状和/或尺寸各异的多种弓丝。总体而言，在治疗过程中，弓丝的使用是从细到粗、从圆到方、从镍钛到不锈钢，因此其特性也从柔软灵活逐渐过渡到坚固稳定。

By doing so, teeth movement can be controlled in a predicted way. However, in clear aligner treatment, for each brand, the same aligner material is used throughout the whole aligner treatment, which is not as flexible as Niti wire nor as stable as stainless-steel wire. Thus, to move individual and/or group of teeth, tooth movement need to be designed in a stepwise mode, according to the natures of specific tooth movements..

通过这样做，牙齿的移动可以以预测的方式进行控制。然而，在隐形矫治器治疗中，对于每个品牌，整个矫治器治疗过程中使用的是相同的矫治器材料，这种材料既不如镍钛丝灵活，也不如不锈钢丝稳定。因此，为了移动单个或一组牙齿，需要根据特定牙齿移动的特性，以分步的方式设计牙齿移动。

Moreover, aligners’ elastic force is directly proportional to the amount of material deformation within a certain range, whereas excessive deformation can lead to plastic deformation, resulting in a loss of the force. Additionally, all the elastic force decreases with the deformation time.

此外，矫治器的弹性力在一定范围内与材料变形量成正比，而过度变形可能导致塑性变形，从而导致力量丧失。此外，所有的弹性力都会随着变形时间的增加而减小。

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Therefore, when designing clear aligners, a series of intermediate statuses is used to bridge the initial and final status. The aligners are regularly replaced, helping the teeth move gradually to the desired position under the effect of a continuous gentle force (Fig.

因此，在设计透明矫治器时，会使用一系列中间状态来衔接初始状态和最终状态。定期更换矫治器，有助于牙齿在持续轻柔力的作用下逐渐移动到预期位置（图。

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Fig. 2

图2

A schematic illustration of the principles of clear aligner therapy for incisor retraction in a premolar-extraction case. A final set-up is designed based on the initial set-up and a final aligner is fabricated based on the final tooth set-up. The final aligner is topologically distinct from the pre-treatment dentition and should be elastically stretched for being fitted onto the dentition.

在前磨牙拔除病例中，用于切牙回收的透明矫治器治疗原理示意图。最终设置基于初始设置进行设计，并根据最终牙齿排列制作最终矫治器。该最终矫治器在拓扑结构上与治疗前的牙齿不同，因此需要弹性拉伸以适配到牙齿上。

The stretched aligner on the pre-treatment dentition is activated and generate retraction force on the anterior teeth and protraction force on the posterior teeth, resulting in premolar-extraction space closure.

预治疗牙列上的拉伸矫治器被激活，在前牙产生后移力量，在后牙产生前移力量，从而导致前磨牙拔除间隙的关闭。

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Thus, the initial, intermediate and final positions are the three keys to the success of clear aligner therapy. The initial position is determined based on patients’ characteristics, especially the digital dental models that capture the intraoral dentition and occlusion. Intermediate positions aim to ensure that the path and rate of tooth movement comply with the biological and biomechanical principles of orthodontic tooth movement.

因此，初始位置、中间位置和最终位置是清晰的矫正器治疗成功的三个关键。初始位置根据患者的特点确定，特别是捕捉口腔内牙齿排列和咬合的数字化牙科模型。中间位置的目标是确保牙齿移动的路径和速率符合正畸牙齿移动的生物和生物力学原理。

The ideal final position necessitates well-aligned dental arches, normal anterior overjet/overbite, and perfect posterior interdigitations..

理想的最终位置需要牙弓排列整齐，正常的前牙覆盖和覆合，以及完美的后牙交错。

Therefore, CAT is essentially a process of tooth repositioning in three dimensions. A critical aspect of this process is the acquisition and redistribution of space. There are currently five main methods for gaining space: arch expansion, molar distalization, incisor proclination, interproximal reduction (IPR), and extraction..

因此，CAT 本质上是一个三维牙齿重新定位的过程。此过程的一个关键方面是空间的获取和重新分配。目前获取空间的主要方法有五种：牙弓扩展、磨牙远移、切牙前倾、邻面去釉 (IPR) 和拔牙。

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Clinical treatment plans should be designed based on individual cases.

临床治疗方案应该根据具体病例来设计。

Next, we will discuss specific strategies for various clear aligner treatments in details, based on the methods of gaining space.

接下来，我们将根据获得空间的方法，详细讨论各种透明矫治器治疗的具体策略。

Clinical procedures of clear aligner treatment

隐形矫治器治疗的临床程序

As illustrated in Fig.

如图所示。

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, clear aligner treatment encompasses nine procedures in clinical practice, starting from diagnosis, clear aligner treatment difficulty assessment based on CAT-CAT, acquisition of digital models and aligner treatment planning. Once the aligner treatment planning is ready, aligner fabrication ensues.

，透明牙套治疗在临床实践中包含九个步骤，从诊断开始，基于CAT-CAT的透明牙套治疗难度评估，数字模型的获取以及牙套治疗计划的制定。一旦牙套治疗计划准备就绪，接下来便是牙套的制作。

Then, clear aligner treatment progresses to clinical section that involves fitting of initial set of aligners, follow-up appointments and monitoring, and end of the active clear aligner treatment. Lastly, retention is required and important following orthodontic treatment..

然后，透明矫正器治疗进展到临床阶段，包括安装初始矫正器、随访预约和监控，以及结束主动的透明矫正器治疗。最后，正畸治疗后需要并重视保持阶段。

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The overview procedures of clear aligner treatment

隐形矫正治疗的概览程序

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Diagnosis

诊断

The precise initial position of the teeth requires complete and accurate patients’ data. And thus, data collection for CAT is essential, including facial and intraoral photographs, radiographic data [panoramic tomography, cephalometric radiographs, and cone beam computed tomography scans (CBCT)], and digital dental models that can be obtained through silicone rubber (PVS) impressions or intraoral scanning..

牙齿的精确初始位置需要完整和准确的患者数据。因此，CAT的数据收集是必不可少的，包括面部和口腔内照片、放射数据［全景断层扫描、头影测量X光片和锥形束计算机断层扫描（CBCT）］，以及可以通过硅橡胶（PVS）印模或口内扫描获得的数字牙科模型。

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Based on these patient data, a meticulous diagnosis is established.

基于这些患者数据，建立了细致的诊断。

CAT-CAT aligner difficulty assessment

CAT-CAT 对齐器难度评估

Orthodontic treatment goals are similar, regardless of treatment modalities. CAT plans should be based on patient complaints, presentation, and diagnosis. CAT can make orthodontic treatment easier, faster and more effective. However, before patients can be recommended for CAT treatment, difficulty level should be assessed (Table .

orthodontic treatment goals are similar, regardless of treatment modalities. CAT plans should be based on patient complaints, presentation, and diagnosis. CAT can make orthodontic treatment easier, faster and more effective. However, before patients can be recommended for CAT treatment, difficulty level should be assessed (Table .

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) to ensure patient suitability. And clinicians should ensure that they have made the correct diagnosis and appropriate treatment plans.

）以确保患者适合。临床医生应确保他们做出了正确的诊断并制定了适当的治疗计划。

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As for some difficult or challenging cases, such as patients with severe periodontitis or needing surgical treatment, multi-disciplinary treatment (MDT) and specialists’ guidance are necessary.

对于一些困难或具有挑战性的病例，如严重牙周炎患者或需要手术治疗的患者，多学科治疗（MDT）和专家指导是必要的。

Digital models

数字模型

As mentioned above, digital models can be acquired through either intraoral scanning or PVS impression taking.

如上所述，数字模型可以通过口内扫描或PVS取模获得。

Aligner treatment planning

对齐器治疗计划

Recently, we developed a novel clear aligner treatment philosophy—biomechanics-guided, esthetics-driven, periodontium-supported and temporomandibular joint-compatible clear aligner therapy (BEPT-CAT)—that can guide practitioners to perform aligner treatment planning.

最近，我们开发了一种新的透明矫治器治疗理念——生物力学引导、美学驱动、牙周支持和颞下颌关节兼容的透明矫治器疗法（BEPT-CAT）——可以指导医生进行矫治器治疗规划。

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Most cases of malocclusion are caused by “incorrect” tooth position, resulting in the discrepancies in necessary and available space. And thus, the treatment principles focus on either increasing the amount of space available or reducing the tooth amount. Common clinical methods for increasing the available space include arch expansion, molar distalization, and incisor proclination, while methods for reducing the tooth amount include IPR and extraction..

大多数错牙合畸形的病例是由“不正确”的牙齿位置引起的，导致必要空间和可用空间之间的差异。因此，治疗原则集中在增加可用空间或减少牙齿数量上。增加可用空间的常见临床方法包括牙弓扩展、磨牙远移和切牙前倾，而减少牙齿数量的方法包括邻面去釉（IPR）和拔牙。

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Arch expansion

拱形扩展

Indications

适应症

Narrow dental arch: a narrow dental arch can be determined based on the relationship between the most prominent points on the buccal surfaces of the crowns of the lower posterior teeth and the Wala ridge.

狭窄的牙弓：可以根据下颌后牙颊面冠部最突出点与Wala嵴之间的关系来确定狭窄的牙弓。

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Pont index analysis and Howes value can also assist in the width assessment.

Pont指数分析和Howes值也可以帮助进行宽度评估。

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Pretreatment CBCT can be used to clarify the spatial relationship between the root and alveolar bone, which helps avoid excessive expansion that may result in bone fenestration or dehiscence.

术前CBCT可用于明确根部与牙槽骨之间的空间关系，有助于避免可能导致骨开窗或骨裂的过度扩展。

Excessive buccal corridor: excessive buccal corridor refers to excess negative space between the dental arch and the buccal mucosa of the oral cavity. Previous studies have shown that an excessive or insufficient buccal corridor jeopardizes smile esthetics.

过度的颊侧走廊：过度的颊侧走廊指牙弓与口腔颊侧黏膜之间过多的负空间。以往的研究表明，过度或不足的颊侧走廊会危及微笑的美观。

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An excessive buccal corridor is indicative of the arch expansion.

过大的颊侧走廊表明了牙弓的扩展。

Considerations for final position design

最终位置设计的考虑因素

Factors that must be considered include arch symmetry, arch coordination, and appropriate expansion amount to prevent bone fenestration or dehiscence. The volume of basal bone on buccal side should be analyzed in CBCT to determine the upper limit of the expansion. The amount of up-to-2 mm expansion on each side is safe in most cases.

必须考虑的因素包括牙弓对称性、牙弓协调性以及适当的扩大量，以防止骨开窗或骨裂开。应在CBCT中分析颊侧基底骨的体积，以确定扩张的上限。在大多数情况下，每侧最多2毫米的扩大量是安全的。

As for adolescents, the greater regenerative potential of alveolar bone remodeling makes arch expansion much safer. To prevent buccal inclination of crowns during expansion, the final position design should ensure that all the expanded posterior teeth are in lingual inclination (from the lateral view, the palatal cusps are invisible) (Fig.

至于青少年，牙槽骨重塑更大的再生潜力使得牙弓扩展更加安全。为防止扩弓过程中牙冠的颊向倾斜，最终位置设计应确保所有扩展后的后牙均呈舌倾（从侧面观，腭侧尖不可见）（图。

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Fig. 4

图4

Aligner treatment planning for arch expansion.

牙弓扩展的对齐器治疗计划。

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A narrow upper arch is to be expanded.

狭窄的上颌弓需要扩展。

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From the buccal view, the palatal cusps of the molars can be observed (yellow arrows).

从颊侧视图可以观察到臼齿的腭侧尖端（黄色箭头）。

c

c

From the posterior view, the palatal cusp (yellow arrow) is more occlusal than the buccal cusps.

从后视图来看，腭侧尖（黄色箭头）比颊侧尖更接近咬合面。

d

d

Buccolingual angulation of the molar is modified and a buccal root-torque is added.

磨牙的颊舌向角度被调整，并增加了颊侧根转矩。

e

e

The palatal cusps cannot be observed from the buccal view

从颊侧观察不到腭侧牙尖。

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Attachment design

附件设计

Attachments are required on the buccal surfaces of teeth during arch expansion to prevent buccal inclination. For teeth with inadequate height of lingual cusps, lingual attachments may be placed simultaneously.

在牙弓扩展过程中，需要在牙齿的颊面放置附件以防止颊倾。对于舌侧牙尖高度不足的牙齿，可同时放置舌侧附件。

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Considerations for staging

考虑事项对于分段

It is recommended to design a staged expansion for any expansion exceeding 1 mm unilaterally, such as a “V-pattern” design like molar distalization. Homonymous teeth in the same jaw are suggested to expand simultaneously because they can act as reciprocal anchorages.

对于任何单侧超过1毫米的扩弓，建议设计阶段性扩弓，例如像磨牙远移这样的“V形”设计。同颌同名牙齿建议同时扩弓，因为它们可以作为相互的支抗。

By adhering to these principles, clinicians can effectively incorporate arch expansion into clear alignment treatment plans, ensuring optimal outcomes in patients with dental arch discrepancies.

通过遵循这些原则，临床医生可以有效地将牙弓扩展纳入透明对齐治疗计划中，确保牙弓差异患者的最佳治疗效果。

Molar distalization

磨牙远移

Indications

适应症

Almost normal facial pattern with distal (Class II) or mesial (Class III) molar relationship may be an indication for molar distalization. It may be accompanied by mild to moderate crowding, deep overjet, or an anterior crossbite/edge-to-edge bite. However, molar distalization is not generally recommended for neutral molar relationship (Class I)..

几乎正常的面部模式，伴有远中（II 类）或近中（III 类）磨牙关系，可能是磨牙远移的适应症。可能伴随轻度至中度拥挤、深覆盖，或前牙反颌/对刃咬合。然而，一般不建议在中性磨牙关系（I 类）的情况下进行磨牙远移。

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Sufficient space in the posterior dental arch is necessary for molar distalization. CBCT evaluation from a three-dimensional perspective is recommended for molar distalization greater than 2 mm. Vertically, the presence of a low maxillary sinus increases the difficulty of upper molar distalization, especially when the molar roots penetrate the cavity.

后牙弓有足够的空间是磨牙远移的必要条件。对于大于2毫米的磨牙远移，建议从三维角度进行CBCT评估。垂直方向上，低位上颌窦的存在增加了上磨牙远移的难度，特别是当磨牙根侵入窦腔时。

Third molar extraction is recommended to reduce distalization resistance and provide more space..

建议拔除第三磨牙以减少远移阻力并提供更多空间。

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Considerations for final position design

最终职位设计的考虑因素

The upper limit of molar distalization of clear aligner treatment depends on the available retromolar space. The third molars can be extracted if there is no sufficient space. The amount of less than 2 mm molar distalization on one side is considered predictable in most cases while the mesio-distal inclination of posterior teeth and the potential of bone growth in children and adolescents should be taken into consideration..

清晰矫治器治疗中臼齿远移的上限取决于可用的后臼齿空间。如果空间不足，可以拔除第三磨牙。在大多数情况下，单侧小于2毫米的臼齿远移被认为是可预测的，但应考虑后牙的近远中倾斜以及儿童和青少年的骨骼生长潜力。

Based on the literature and clinical experience, the predictability of molar distalization using clear aligners is approximately 88%.

基于文献和临床经验，使用透明矫治器进行磨牙远移的可预测性约为88%。

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Thus, it is feasible to design the final position based on the actually required distalization distance (i.e., to obtain a neutral relationship) where no or minimal overtreatment is required. Additionally, to prevent labial fenestration and/or dehiscence in the lower anterior region, it is necessary to avoid labial movement of the lower anterior teeth, particularly the roots.

因此，可以根据实际所需的远移距离（即达到中性关系）来设计最终位置，这样可以避免或最小化过度治疗。此外，为防止下前牙区域出现唇侧骨开窗和/或骨开裂，有必要避免下前牙特别是牙根的唇向移动。

This is because class II intermaxillary elastics are commonly applied during upper molar distalization, which exert a mesial force on the lower arch and labially push the lower anterior teeth..

这是因为II类颌间牵引通常在上磨牙远中移动过程中使用，其对下牙列施加近中力，并将下前牙向外侧推动。

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Attachment design

附件设计

Molar distalization does not require the supplement of attachments. However, attachments are recommended to enhance the grip of teeth with short crowns. Moreover, molar distalization is often accompanied by other complex movements such as intrusion and rotation, and attachments are usually required to improve the success rates of these movements and prevent off-tracking.

磨牙远移不需要附件的补充。然而，建议使用附件来增强短冠牙齿的抓力。此外，磨牙远移通常伴随着其他复杂运动，如压低和旋转，通常需要附件来提高这些运动的成功率并防止脱轨。

Traditional rectangular attachments are generally designed for the canines to increase the retention of aligners and minimize the impact of precision cuts..

传统矩形附件通常设计用于犬齿，以增加矫治器的固位性并尽量减少精确切割的影响。

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Intermaxillary elastics

牙弓间橡皮筋

When clear aligners exert a pushing force to achieve molar distalization via material deformation, the counteracting force may procline the anterior teeth. Thus, if anterior tooth proclination is undesirable, the anchorage of the anterior teeth should be reinforced. Intermaxillary elastics are commonly used in practice to achieve this aim..

当透明矫治器通过材料变形施加推力以实现臼齿远中移动时，反作用力可能会使前牙唇倾。因此，如果前牙唇倾是不希望出现的情况，就应该加强前牙的支抗。在实践中，通常使用颌间橡皮筋来达到此目的。

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In maxillary molar distalization, precision cuts are designed at the maxillary canines, whereas buttons are bonded to the buccal surface of the mandibular first molars (cut out on lower aligners) to allow the use of Class II intermaxillary elastics (Fig.

在上颌磨牙远中移动中，精确的切口设计在上颌尖牙处，而按钮则粘接在下颌第一磨牙的颊面（在下颌矫治器上切割）以允许使用II类颌间橡皮筋（图。

5a

5a

).

）。

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If simultaneous eruption of the canine is desirable (e.g., low positioned or insufficiently erupted canines), a button can be bonded to the labial surface of canine near the gingival margin to facilitate eruption (Fig.

如果希望犬齿同时萌出（例如，位置低或萌出不充分的犬齿），可以在靠近牙龈边缘的犬齿唇面粘接一个按钮，以促进萌出（图。

5b

5b

). However, precision cuts at the mandibular molars are prone to aligner displacement or off-tracking and are not recommended. Additionally, if necessary, implant devices can be used to enhance the anchorage, provided they do not obstruct molar distalization.

）。然而，下颌磨牙的精确切割容易导致矫治器移位或脱轨，因此不建议使用。此外，如果必要，可以使用种植体装置来增强支抗，只要它们不妨碍磨牙的远中移动。

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On the other hand, if the proclination of anterior teeth is desirable (e.g., Class II Division 2), it can be designed simultaneously with molar distalization, acting as reciprocal anchorage to eliminate the need for any elastics.

另一方面，如果前牙的唇倾是有利的（例如，II类2分类），可以与臼齿远中移动同时设计，作为相互支抗以消除对任何橡皮筋的需求。

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Nevertheless, anterior proclination and molar distalization should be closely monitored during follow-up appointments for real-time adjustments.

然而，在随访预约期间，应密切监测前牙的前倾和磨牙的远中移动，以便进行实时调整。

Fig. 5

图5

Different modes of elastic tractions.

弹性牵引的不同模式。

a

a

Class II elastic traction is applied on the precision cut on the upper aligner.

II 类弹性牵引力施加在上部矫治器的精确切割处。

b

b

A cut-out is designed on the upper canine and class II elastic traction is engaged ono the button on the canine

在上犬齿处设计了一个切口，并在犬齿的按钮上进行了II类弹性牵引。

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Considerations for staging

考虑事项 staging

The staging of tooth movements involves the consideration of anchorage. Typically, molar distalization is designed in a “V-patten” staging, in which the second molars are moved first, and then the first molars once the second molars have reached the halfway point of their total moving distance; thereafter, the second premolars start to move once the second molars have completed their “journey” (Fig.

牙齿移动的分期涉及对支抗的考虑。通常，磨牙远移设计为“V型”分期，即先移动第二磨牙，当第二磨牙移动到总移动距离的一半时，再移动第一磨牙；此后，第二前磨牙在第二磨牙完成其“旅程”后开始移动（见图）。

.

。

6a

6a

). Thus, no more than four teeth are distalized at each stage (V-pattern).

）。因此，每个阶段最多只有四颗牙齿被远中移动（V型模式）。

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Finally, the space created by canine distalization can be used to align and/or retract the anterior teeth. By doing so, the anchorage is often adequate for most distalization cases; however, a long-term treatment is unavoidable.

最后，通过犬齿远移创造的空间可以用于排齐和/或内收前牙。这样做时，对于大多数远移病例，支抗通常足够；然而，长期的治疗是不可避免的。

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In some cases, in order to shorten the treatment duration and increase patient compliance and cooperation, alignment of the anterior teeth is performed simultaneously with molar distalization, allowing patients to observe quick esthetic changes (Fig.

在某些情况下，为了缩短治疗时间并提高患者的依从性和配合度，前牙排列与臼齿远移同时进行，使患者能够观察到快速的美观变化（图。

6b

6b

). In addition, implant screws can be used to strengthen anchorage, allowing more teeth to distalize simultaneously, to shorten treatment duration (Fig.

）。此外，可以使用种植体螺钉来增强锚固力，使更多的牙齿同时向远中移动，从而缩短治疗时间（图。

6c

6c

).

）。

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Fig. 6

图6

Different aligner design patterns for molar distalization.

用于磨牙远移的不同矫治器设计模式。

a

a

Strict V-pattern. Molars, premolars and anterior teeth move sequentially.

严格的V形模式。臼齿、前臼齿和前牙依次移动。

b

b

Modified V-pattern. Incisors move alongside molar distalization.

改良V形模式。切牙随着磨牙远中移动而移动。

c

c

The first and second molars move simultaneously

第一和第二磨牙同时移动

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Proclination of anterior teeth

前牙的唇倾

Indications

适应症

Patients presenting with straight or concave facial profiles and retro-inclined or upright anterior teeth accompanied by mild crowding, such as cases with deep overbite caused by lingual inclination of the upper anterior teeth, are indicated for proclination of anterior teeth, which can be combined with other methods to obtain enough space..

面部轮廓平直或凹陷，前牙后倾或直立并伴有轻度拥挤的患者，如下前牙深覆合由上前牙舌倾引起的情况，适合前牙唇展，结合其他方法获得足够间隙。

Considerations for final position design

最终位置设计的考虑因素

The sagittal position and proclination of the anterior teeth, especially the upper anterior teeth, are crucial for facial esthetics and are one of the main indicators for profile analysis.

前牙尤其是上切牙的矢状向位置和倾斜度，对面部美学至关重要，并且是轮廓分析的主要指标之一。

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Thus, the degree of proclination of the anterior teeth should be carefully evaluated based on facial morphology, and a combination with other methods that help acquire sufficient space should be considered. For patients with a severe lingually inclined deep anterior overbite, the roots-and-bone relationship should be considered.

因此，应根据面部形态仔细评估前牙的前倾程度，并考虑结合其他有助于获取足够空间的方法。对于严重的舌侧倾斜深前牙覆盖患者，应考虑牙根与骨骼的关系。

The roots need to be positioned within the cancellous region of the alveolar bone..

牙根需要位于牙槽骨的松质骨区域内。

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Theoretically, a proclination of 1 mm (2.5°) in the anterior segment provides 2 mm of space. Therefore, the proclination design in the final position is based on the amount of space required, facial morphology, and the roots-and-bone relationship.

理论上，前牙段 1 毫米（2.5°）的唇倾可提供 2 毫米的空间。因此，最终位置的唇倾设计取决于所需的空间量、面部形态以及牙根与骨骼的关系。

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Attachment design

附件设计

More than 3° of incisor proclination activates the power ridge in the designing software system, which applies labial-torquing force on the crowns, whereas lingual-torquing force on the roots and effectively achieves root-controlled movement of the anterior teeth.

超过3°的切牙前倾会激活设计软件系统中的力量嵴，该系统会对牙冠施加唇向扭矩力，而对牙根施加舌向扭矩力，从而有效实现前牙的根控制移动。

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Traditional attachments on canines are recommended to reduce the risk of aligner off-tracking in the anterior segment.

传统上建议在犬齿上使用附件，以减少前牙部分对齐器脱轨的风险。

Considerations for staging

考虑事项对于分段

A minor proclination can be synchronized with the alignment of mild crowding. However, in cases with lingually inclined deep overbite, staged tooth movement is required. Proclination is first performed to torque the roots into the cancellous bone, and then followed by intrusion and retraction of the anterior teeth..

轻微的前倾可以与轻度拥挤的排列同步进行。然而，在舌侧倾斜深覆合的情况下，则需要分阶段移动牙齿。首先进行前倾以将牙根扭入松质骨，然后随之进行前牙的压低和后移。

Interproximal reduction (IPR)

牙齿邻面去釉 (IPR)

Indications

适应症

Although IPR is a method for gaining space, it has always been controversial because of the potential damage to the enamel and the resulting risk of caries. The authors suggested that IPR should be used as a supplement to other methods, rather than as the primary method, to gain space. The following situations warrant an IPR design.

虽然IPR是一种获取间隙的方法，但因可能对釉质造成损伤并因此引发龋齿风险，一直存在争议。作者建议，IPR应作为其他方法的补充，而非主要手段来获取间隙。以下情况适合采用IPR设计。

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：

Bolton discrepancy due to the missing teeth or malformed teeth.

由于牙齿缺失或牙齿畸形导致的博尔顿差异。

Gingival embrasure defects (black triangles) due to periodontal disease.

因牙周病导致的牙龈间隙缺损（黑三角）。

Poor crown morphology with contact points nearby the incisal edge.

冠部形态不佳，接触点靠近切缘。

Considerations for final position design

最终位置设计的考虑因素

In general, IPR is designed in the anterior segment, if needed. It is advisable to limit the maximum amount of IPR to 0.25 mm on the proximal surface of each tooth. Studies have shown that IPR amounting to no more than 50% of the enamel thickness generally does not increase the risk of caries.

一般来说，IPR设计在前牙段，如果需要的话。建议将每个牙齿邻面的IPR最大量限制在0.25毫米。研究表明，IPR不超过牙釉质厚度的50%通常不会增加龋齿的风险。

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Considerations for staging

考虑事项 staging

Since the IPR site is the anatomical contact point of the crown rather than the actual contact point, restoring normal contact points first undoubtedly facilitates IPR performance. However, in practice, there may be situations in which insufficient space hinders the alignment of the dental arch, which requires a comprehensive assessment of the timing of IPR.

由于IPR位点是冠部的解剖接触点，而非实际接触点，因此首先恢复正常的接触点无疑有助于IPR的实施。然而，在实践中，可能会出现因空间不足而阻碍牙弓排列的情况，这就需要对IPR的时机进行全面评估。

Graded IPR is recommended to alleviate this contradiction. Fluoride application after IPR performance is suggested..

建议采用分级的IPR来缓解这一矛盾。在IPR操作后建议使用氟化物。

Tooth extraction

拔牙

Tooth extraction is a common method for reducing tooth amount in orthodontic treatment and is mainly indicated when the discrepancy between the available and required space exceeds 8 mm, such as in cases with severe crowding or severe maxillary and/or mandibular protrusions. Two types of tooth extraction patterns are commonly used in clear alignment treatment: extraction of lower incisor and extraction of premolars (first or second)..

拔牙是正畸治疗中减少牙齿数量的常用方法，主要用于可用空间与所需空间的差异超过8毫米的情况，例如严重拥挤或严重的上颌和/或下颌前突病例。在隐形矫治治疗中，常用的拔牙模式有两种：下切牙拔除和前磨牙（第一或第二前磨牙）拔除。

Extraction of lower incisors

下切牙拔除

Indications

适应症

An almost normal facial pattern with stable posterior occlusion, no indication for upper extraction, and the total required space in the mandible exceeding 6 mm.

几乎正常的面部形态，后牙咬合稳定，无上颌拔牙指征，下颌总需间隙超过6毫米。

Bolton ratio discrepancy due to missing teeth or malformed teeth in maxilla.

由于上颌缺牙或牙齿畸形导致的博尔顿比率差异。

Poor prognosis of a lower incisor due to periodontal disease or dental trauma.

由于牙周病或牙齿外伤导致下切牙预后不良。

Considerations for final position design: The extraction of a lower incisor results in the lack of the midline of the lower dental arch. Instead, the long axis of the lower central incisor may be designed as the lower midline. In most cases, IPR of the upper anterior teeth is necessary to resolve the discrepant Bolton ratio and achieve normal anterior overbite and overjet..

最终位置设计的考虑因素：下切牙的拔除会导致下牙弓中线的缺失，此时可将下中切牙的长轴设计为下中线。在大多数情况下，需要对上切牙进行邻面去釉（IPR），以解决不匹配的Bolton比例，并实现正常的前牙覆合和覆盖。

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Attachment design: it is recommended to design vertical rectangular attachments or root-control attachments on the adjacent teeth to the extraction space, which facilitate the reciprocal movement of the adjacent teeth, especially their roots.

附件设计：建议在拔牙间隙的邻牙上设计垂直矩形附件或控根附件，以利于邻牙的相互移动，尤其是牙根的移动。

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Considerations for staging: extracting a lower incisor can effectively relieve crowding in the lower anterior section and provide space for the intrusion of the lower anterior teeth, resulting in a high rate of treatment success. Therefore, special staging considerations are generally not required.

考虑分期拔除：拔除下切牙能有效缓解下前部的拥挤状况，并为下前牙的压低提供空间，从而获得较高的治疗成功率，因此一般不需要特别的分期考虑。

Extraction of the first premolars

第一前磨牙的拔除

Based on the symmetry principle, the extraction of the first 4 premolars is the most common pattern of extraction in orthodontic practice. However, cases needing the extraction of 4 premolars belong to difficult level in CAT (Table

基于对称性原则，前磨牙中前4颗的拔除是正畸实践中最常见的拔牙模式。然而，需要拔除4颗前磨牙的病例在CAT中属于难度级别（表）。

1

1

), and clinicians need to reach a certain level of orthodontic experience to complete the treatment.

），临床医生需要达到一定的正畸经验水平才能完成治疗。

Indications: Extraction of the first 4 premolars is indicated when the discrepancy between the available and required space exceeds 8 mm, such as cases with severe crowding and/or bimaxillary protrusion, and etc.

指示：当可用空间与所需空间的差异超过8毫米时，建议拔除前4颗前磨牙，例如严重拥挤和/或双颌前突等情况。

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Considerations for final position design: most cases with tooth extraction are challenging to treat, as extensive tooth movement is unavoidable, requiring three-dimensional repositioning of these teeth. Treatment success relies on the torque control of the anterior teeth and the mesial-tipping avoidance of the posterior teeth..

最终位置设计的考虑因素：大多数拔牙病例治疗起来都具有挑战性，因为不可避免地需要进行广泛的牙齿移动，并对这些牙齿进行三维重新定位。治疗成功依赖于前牙的扭矩控制和后牙的近中倾斜避免。

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Therefore, the final position requires an over-treatment design, as follows:

因此，最终位置需要一个过度治疗设计，如下所示：

Anterior teeth exhibit a labial inclination with incisor angles of approximately 120°. To prevent excessive lingual inclination, adequate labial inclination and torque control (root-lingual torque) should be designed during the whole procedure of anterior retraction.

前牙呈现唇向倾斜，切牙角约为120°。为防止过度舌倾，在前牙回收的整个过程中应设计适当的唇向倾斜和扭矩控制（根舌向扭矩）。

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Cases with more lingual inclination at the initial and/or longer retraction distances require a larger positive torque in the design.

初始阶段舌侧倾斜较大和/或回收距离较长的病例在设计时需要更大的正向扭矩。

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Anterior teeth are in a shallow overjet/overbite or edge-to-edge position without occlusal contact. The pendulum effect of anterior retraction, compounded by any pre-existing deep bite condition, may require the over-treatment of anterior intrusion.

前牙呈浅覆盖/覆合或边缘对边缘位置，无咬合接触。前牙后缩的钟摆效应，加上任何预先存在的深覆合情况，可能需要对前牙进行过度压低治疗。

Canines are mesially tipped with the roots closer to the extraction space.

犬齿向近中倾斜，其根部更靠近拔牙空间。

Posterior teeth are distally tipped, with additional negative torque to prevent buccal inclination of molars and loss of posterior anchorage.

后牙向远中倾斜，并施加额外的负转矩，以防止臼齿颊侧倾斜和后部支抗的丧失。

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Attachment design: In such cases, attachment design should consider the following:

附件设计：在这种情况下，附件设计应考虑以下因素：

Power ridge on incisors is recommended to aid in the torque control of the anterior teeth, which can be activated when more than 3° root-lingual torque is designed.

建议在切牙上施加力量嵴以帮助控制前牙的转矩，当设计超过3°根舌侧转矩时可以激活。

Optimized attachments with strong root control or traditional rectangular attachments are recommended for the canines.

建议对犬牙使用具有强根控制的优化附件或传统的矩形附件。

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Horizontal rectangular attachments with strong retention are recommended for posterior teeth.

建议后牙使用固位力强的水平矩形附件。

Intermaxillary elastics: To increase posterior anchorage, Class II elastics can be designed during anterior retraction (precision cuts at the upper canines and bonding of buttons on the buccal surface of the lower first molars). Alternatively, implant anchorage can be used in the anterior region to assist the intrusion and body retraction of the anterior teeth..

颌间牵引：为了增强后牙支抗，可以在前牙内收过程中设计II类牵引（上尖牙处的精确切割及下第一磨牙颊侧粘接扣）。或者，可以在前牙区域使用种植体支抗，以协助前牙的压低和整体内收。

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Different modes of elastic tractions with or without mini-implants and their corresponding biomechanics are displayed in Fig.

图中展示了不同模式的弹性牵引力，有或没有迷你种植体及其相应的生物力学。

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Fig. 7

图7

Different elastic tractions and biomechanical features.

不同的弹性牵引力和生物力学特性。

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A class II elastic traction is applied between the precision cut on the upper canine and the button on the lower first molar. Since the traction force (blue dashed line) passes occlusally to the center of resistance (red dot) of the upper anterior teeth, a clockwise moment (blue curved arrow) is generated.

在上犬齿的精密切割处和下第一磨牙的按钮之间施加了II类弹性牵引。由于牵引力（蓝色虚线）通过上切牙阻力中心（红点）的咬合方向，因此产生了顺时针力矩（蓝色弯曲箭头）。

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An elastic traction is engaged between the precision cut on the upper canine and a buccal mini-implant. Likewise, a smaller clockwise moment (blue curved arrow) is generated.

在上犬齿的精确切割处和颊侧迷你种植体之间施加了弹性牵引力。同样，会产生一个较小的顺时针力矩（蓝色弯曲箭头）。

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One elastic traction is applied between the precision cut on the canine and a buccal mini-implant and the other one is engaged between the aligners on the incisors and a labial mini-implant. The retraction force (blue dashed line) generates a clockwise moment (blue curved arrow) while the intrusion force (yellow dashed line) offers a counterclockwise moment (yellow curved arrow).

一根弹性牵引线施加在犬齿上的精密切割处和颊侧迷你种植体之间，另一根则作用于切牙上的对齐器与唇侧迷你种植体之间。后移力（蓝色虚线）产生一个顺时针力矩（蓝色弯曲箭头），而压入力（黄色虚线）提供了一个逆时针力矩（黄色弯曲箭头）。

The two moments are offset by each other and the anterior teeth are retraction in a bodily movement mode.

两个力矩相互抵消，前牙以整体移动的方式进行回收。

Full size image

全尺寸图像

Considerations for staging: a personalized design is suggested for each case. The staging design should vary according to the specific circumstances because of the complex and variable nature of extraction cases. However, in most cases, we recommend distalizing canines and distal tipping of the posterior teeth (anchorage preparation) first.

考虑分期治疗的建议：针对每个病例建议采用个性化设计。由于拔牙病例的复杂性和多变性，分期设计方案应根据具体情况而有所不同。然而，在大多数情况下，我们建议首先远中移动尖牙并远中倾斜后牙（支抗预备）。

When canines complete the first third of the total moving distance, 6 anterior teeth start to move simultaneously by then. And finally, mesial movement of the posterior teeth begins when anterior teeth movement is completed. To prevent the “bowing effect”, it is suggested to avoid mesial movement of the posterior teeth simultaneously with the retraction of anterior teeth..

当犬牙完成总移动距离的前三分之一时，6颗前牙开始同时移动。最后，当前牙移动完成后，后牙的近中移动开始。为防止“弓形效应”，建议避免后牙的近中移动与前牙的回收同时进行。

Extraction of the second premolars

第二前磨牙的拔除

Indications: In the following cases, second premolars are extracted instead of first premolars, which usually increases the treatment difficulty. Clinicians should be cautious to make a treatment scheme design like this:

指示：在以下情况下，拔除第二前磨牙而不是第一前磨牙，这通常会增加治疗难度。临床医生应谨慎设计这样的治疗方案：

Serious damage/abnormality on the second premolar and/or its periodontal tissue.

第二前磨牙及其牙周组织出现严重损伤/异常。

Second premolar is impacted or blocked-out of the dental arch.

第二前磨牙阻生或被挤出牙弓。

Minimal anchorage design.

最小锚固设计。

Considerations for final position design: Compared to those in the first premolar extracted case, molars should be designed with more distal inclination (anchorage preparation) since the molars are more prone to mesial tipping, especially in the cases that more than 3 mm mesial movement of molars is required (minimal anchorage design), while less over-treatment of anterior teeth is needed..

最终位置设计的考虑因素：与拔除第一前磨牙的情况相比，由于磨牙更容易近中倾斜，特别是需要磨牙近中移动超过3毫米的情况（最小支抗设计），磨牙应设计为更大的远中倾斜（支抗预备），而前牙则不需要过多的过度治疗。

Considerations for staging: we suggest, firstly, a sequential distal movement of the first premolars and canines, and distal-tipping anchorage preparation of the first molars. Then, move anterior teeth afterwards. And finally, mesially move the molars sequentially.

关于分期治疗的考虑：我们建议，首先顺序远移第一前磨牙和尖牙，并进行第一磨牙的远中倾斜支抗预备。然后，再移动前牙。最后，依次近中移动磨牙。

Bite jump (surgical and growth jump)

咬合跳跃（手术和生长跳跃）

A bite jump refers to the changes in the three-dimensional position of the mandible and/or mandibular dental arch resulting from intermaxillary elastics, self-growth, and/or orthognathic surgery. It is important to note that the design of bite jump should be tailored based on the specific circumstances of the patient, and clinical feasibility should be considered.

咬合跳跃是指由于颌间牵引、自体生长和/或正颌手术导致的下颌骨和/或下颌牙弓三维位置的变化。需要注意的是，咬合跳跃的设计应根据患者的具体情况进行个性化调整，并考虑临床可行性。

Except orthognathic surgery, bite jumps caused by other methods develop gradually in clinical practice, which can span the whole course of treatment..

除了正颌外科手术外，临床上由其他方法引起的咬合跳跃是逐渐发展的，可以贯穿整个治疗过程。

Indications:

适应症：

Adolescents with mild skeletal or functional mandibular hypoplasia or retrognathia;

具有轻度骨骼或功能性下颌骨发育不全或后缩的青少年；

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Functional Class III, with the mandible being able to retrude to edge-to-edge occlusion;

功能性III类，下颌能够后退到切缘相对的咬合位置；

Severe skeletal deformities requiring orthodontic-orthognathic treatment

严重骨骼畸形需要正畸-正颌治疗

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Mandibular malposition caused by premature individual tooth contacts.

由个别牙齿过早接触引起的下颌错位。

Intermaxillary elastics: The sagittal bite jump requires the use of intermaxillary elastics or orthodontic appliances with mandibular advancement function.

颌间牵引：矢状咬合跳跃需要使用颌间牵引橡皮筋或具有下颌前移功能的正畸矫治器。

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Considerations for staging: In the design software, bite jump can be placed at any stage of the treatment or throughout the treatment process. The authors typically place bite jump at the end of the treatment, which makes it easier for clinicians to assess the amount and direction of the jump and detect any abnormalities in a timely manner during clinical monitoring..

分期考虑：在设计软件中，咬合跳跃可以放置在治疗的任何阶段或整个治疗过程中。作者通常将咬合跳跃放置在治疗结束时，这使得临床医生更容易评估跳跃的量和方向，并在临床监测期间及时发现任何异常。

Below, we are going to delve into some special considerations in clear aligner design. A lot of clinicians are confused by these issues in practice.

下面，我们将深入探讨透明矫正器设计中的一些特殊考虑因素。许多临床医生在实践中对这些问题感到困惑。

Special considerations in clear aligner design

隐形矫治器设计中的特殊考虑因素

Over-treatment design: as we discussed before, clear aligners exert mainly a “pushing force”, and therefore their clinical efficiency varies among different types of teeth movements (Fig.

过度治疗设计：正如我们之前讨论的，透明矫正器主要施加“推力”，因此其临床效率在不同类型的牙齿移动中会有所不同（图。

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). To better realize the actual teeth movement, over-treatment design is recommended in some cases, which is related to the predictability of CAT. For example, to intrude anterior teeth and correct deep bite, a shallow overbite and even open bite is designed in the final position, while large positive torque may be given to the incisors which are lingual inclined or up-righted initially when retraction of anterior teeth is required to correct the convex profile.

). 为了更好地实现牙齿的实际移动，在某些情况下建议进行过矫治设计，这与CAT的可预测性有关。例如，为了压低前牙并矫正深覆合，最终位置可能会设计为浅覆合甚至开合，而当需要内收前牙以矫正凸面型时，可能需要对初始舌倾或直立的切牙施加较大的正扭矩。

However, the appropriate amount of over-treatment design is determined case by case, and until now, there is no consensus on this specific issue. According to our experience and previous clinical studies, the amount of over-treatment should be designed based on the initial status of teeth and the type and amount of the teeth movement..

然而，过度治疗设计的适当量需根据具体情况而定，目前在这一具体问题上尚无共识。根据我们的经验和以往的临床研究，过度治疗的量应根据牙齿的初始状态以及牙齿移动的类型和量来设计。

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Challenges and strategies in the complex tooth movements: compared to expansion and molar distalization, intrusion, extrusion and torque control are more complex tooth movements in CAT, which have much lower predictability (Fig.

复杂牙移动中的挑战与策略：与扩弓和磨牙远移相比，CAT中的压低、伸长和转矩控制是更为复杂的牙移动，其可预测性要低得多（图。

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). Thus, over-treatment is commonly designed for these types of movements.

). 因此，过度治疗通常是为这些类型的运动设计的。

Besides, sufficient space for tooth movements should be taken into considerations. For intrusion, the root-and-bone relationship needs to be analyzed in CBCT images to make sure that the roots are in the cancellous bones, while for extrusion, the intermaxillary space is required. And loose proximal contact points are always good for the movement..

此外，还应考虑牙齿移动的足够空间。对于压入，需要在CBCT图像中分析牙根与骨骼的关系，以确保牙根位于松质骨中；而对于牵出，则需要颌间空间。并且，松散的邻接点总是有利于移动。

Then, sufficient anchorage for the movement is important. There are usually two ways to strengthen anchorage in CAT. One is to move teeth in a stepwise mode. We recommend a “Frog pattern” staging for anterior teeth intrusion, in which incisors and canines are intruded separately and in cycles (Fig. .

然后，足够的支抗对于移动是很重要的。在CAT中通常有两种加强支抗的方法。一种是逐步移动牙齿。我们推荐一种“青蛙模式”来进行前牙压低，其中门牙和犬牙分别以循环的方式进行压低（图。

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). Extrusion of posterior teeth is suggested to be designed in a “V pattern” staging. Besides, power ridge design and positive torque is distributed in the whole procedure of incisor retracting to provide a better torque control. The other way to enhance anchorage is to use auxiliary devices and elastics, such as temporary anchorage devices (TAD) implanted in the anterior section to provide an extra intruding force and root lingual torque on anterior teeth (Fig.

）。建议后牙的伸长设计为“V形”分期模式。此外，在切牙回缩的整个过程中，采用动力嵴设计和正扭矩分布，以提供更好的扭矩控制。另一种增强支抗的方法是使用辅助装置和橡皮筋，例如植入前段的临时支抗装置（TAD），以为前牙提供额外的压入力和根舌侧扭矩（图。

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Fig. 8

图8

Staging design for the intrusion of anterior teeth in the lower arch.

下牙弓前牙侵入的分期设计。

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Incisors and canines are intruded in an alternate mode. Incisors are intruded first (referred to stage 1), followed by the intrusion of canines (referred to stage 2). Then, incisors are further intruded (referred to stage 3).

门牙和犬牙以交替模式被压入。首先压入门牙（称为阶段1），接着压入犬牙（称为阶段2）。然后，进一步压入门牙（称为阶段3）。

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Lower arch models showing intrusion of canines and incisors corresponding to the aforementioned three stages.

下颌模型显示了与上述三个阶段相对应的犬齿和门齿的内陷。

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Anterior and side views showing the successful intrusion of the anterior teeth

显示前牙成功侵入的前后和侧面观

Full size image

全尺寸图像

Furthermore, appropriate attachment design could provide clear aligners with greater retention, which is the key for CAT. Traditional attachments on premolars are recommended when intrusion of anterior teeth is needed while traditional attachments on canines are suggested for incisor’s torque control..

此外，适当的设计附件可以为透明矫正器提供更大的固位力，这是CAT的关键。当下前牙需要压低时，建议在前磨牙上使用传统附件；而当需要控制切牙的扭矩时，建议在尖牙上使用传统附件。

Differences in the design of CAT between adolescents and adults: as we know, the main difference between adolescents and adults is growth potential which may lead to different orthodontic treatment plan. Mandible growth can result in anteroposterior bite jump, and thus, bite jump design without surgery is more possible to realize in adolescents.

青少年和成人CAT设计上的差异：我们知道，青少年和成人的主要区别在于生长潜力，这可能导致不同的正畸治疗计划。下颌骨的生长可能会导致前后咬合跳跃，因此在青少年中更有可能实现无需手术的咬合跳跃设计。

Besides, the prevalence of oral caries is higher in adolescents, and therefore, interproximal reduction (IPR) design should be used more cautiously. Moreover, traditional attachments or optimized attachments in larger size are recommended in adolescents due to their inadequate crowns. A recently published expert consensus on adolescents’ orthodontic treatment has deeply discussed this special issue..

此外，青少年龋齿患病率较高，因此邻面去釉（IPR）设计应更加谨慎使用。此外，由于青少年牙冠不足，建议使用传统或较大尺寸的优化附件。最近发布的关于青少年正畸治疗的专家共识已深入探讨了这一特殊问题。

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Aligner fabrication

对齐器制造

Once aligner treatment planning is ready, clear aligners that move teeth incrementally can be fabricated based on either thermoforming or 3D printing.

一旦对齐器治疗计划准备就绪，就可以基于热成型或3D打印制作出逐步移动牙齿的透明对齐器。

Fitting of initial set of aligners

初始矫正器套装的安装

Patients are informed to the clinic for the initial appliance placement when clinicians receive the aligners. On this day, the resin attachments are bonded onto the teeth according to the digital design, and the first set of aligners is tried in (fitness should be checked). Subsequently, patients are issued a set of instructions, including the required wearing duration, method of aligner placement, and usage of chewies.

当临床医生收到矫治器时，会通知患者到诊所进行初次佩戴。当天，根据数字设计将树脂附件粘接在牙齿上，并试戴第一副矫治器（应检查贴合度）。随后，患者会收到一份说明，包括所需的佩戴时长、矫治器的放置方法以及咬胶的使用。

The patients are also informed about the importance of oral hygiene. Additional information and instructions are provided to the patients, as relevant, depending on the tooth movement plan, such as molar distalization, IPR, or extraction..

还告知患者口腔卫生的重要性。根据牙齿移动计划（如磨牙远移、IPR或拔牙）的相关性，向患者提供额外的信息和指导。

Follow-up monitoring

随访监测

Patient compliance management

患者依从性管理

Regular follow-up visits are essential and can be used to inform patients about treatment progress and challenges, helping them understand their roles in the process, increasing their confidence, compliance, and cooperation.

定期随访至关重要，可用于告知患者治疗进展和挑战，帮助他们理解自己在治疗过程中的角色，增强信心、依从性和合作性。

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Cooperation in the long duration of orthodontic treatment is a huge challenge to majority of people, especially persisting in wearing clear aligners day by day. Thus, close contact with patients helps to know their status and give them a hand or timely reminding if needed. Pleasure communication and compliments on patients are always effective in maintaining good relationship between clinicians and patients, which is beneficial for the cooperation as well.

长期的正畸治疗中的配合对大多数人来说是一个巨大的挑战，尤其是日复一日地坚持佩戴透明牙套。因此，与患者保持密切联系有助于了解他们的状态，并在需要时给予帮助或及时提醒。愉快的沟通和对患者的赞美总是有助于维持良好的医患关系，这对治疗的配合也是有益的。

To encourage patients, practitioners can show them the changes already occurred by comparing with their pre-treatment photos and inform them that all these changes are owing to their compliance and cooperation. Let patients be aware of that their efforts will pay back. By doing so, patients will be more confident in the treatment..

为了鼓励患者，医生可以通过与治疗前的照片作对比，向患者展示已经发生的变化，并告知他们所有这些变化都归功于他们的依从性和配合。让患者意识到他们的努力会有回报。通过这种方式，患者会对治疗更加有信心。

Besides, some application programs registered by patients’ ID number can be used on smart cell phone to help record the wearing date and remind to change a new set, which is convenient for patients in daily life.

此外，一些由患者身份证号码注册的应用程序可以用于智能手机上，以帮助记录佩戴日期并提醒更换新的，这对患者的日常生活很方便。

Things to do in the follow-up visits

随访中需要做的事情

To evaluate treatment progress, comprehensive examinations should be performed, including the following assessment:

为了评估治疗进展，应进行全面的检查，包括以下评估：

Tooth and periodontium status assessment, including mobility, premature contact presence, and occlusal trauma.

牙齿和牙周组织状况评估，包括松动度、早接触存在与否以及咬合创伤。

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Occlusion changes, including the sagittal relationship, occlusal contacts, inclination, midline of upper/lower dental arch, overjet, overbite, torque and space, comparing to baseline and digital design.

包括矢状关系、咬合接触、倾斜度、上下牙弓中线、覆盖、覆合、扭矩和间隙等在内的遮挡变化，与基线和数字化设计进行比较。

Temporomandibular joint health assessment should interrogate any pain, tenderness, and clicking in the joint area, especially in patients with temporomandibular disease before treatment and in adult patients using intermaxillary elastics.

颞下颌关节健康评估应询问关节区域是否有任何疼痛、压痛和弹响，尤其是在治疗前患有颞下颌疾病的患者以及使用颌间牵引橡皮筋的成年患者。

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Any detachment and/or abrasion of attachments should be checked according to digital design.

任何脱离和/或附件的磨损均应根据数字设计进行检查。

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Aligner fitness assessments account for the progress in tooth movement, especially any gap observed in the space from the incisal edges of the anterior teeth, cusps of the posterior teeth, and the area around the attachments and along the aligner margin.

矫正器适应性评估考虑了牙齿移动的进展，特别是从前牙切缘、后牙牙尖、附件周围以及矫正器边缘区域观察到的任何间隙。

Management of off-tracking

管理偏离跟踪

Off-tracking refers to the incomplete fitting between the teeth and aligners, indicative of a discrepancy between the direction and/or distance of actual tooth movement and that planned in the digital design (Fig.

偏移是指牙齿与矫治器之间的不完全贴合，表明实际牙齿移动的方向和/或距离与数字设计中规划的存在差异（图。

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). The management of off-tracking involves removing attachments and using aligners to guide the off-tracking teeth back into the desired path using intra-/inter-maxillary elastics. Off-tracking manifestations can be categorized into the following three situations:

）。脱轨的管理涉及移除附件并使用对齐器，通过牙弓内/间弹性牵引将脱轨的牙齿引导回预期路径。脱轨的表现可以分为以下三种情况：

Off-tracking in the vertical dimension due to insufficient extrusion or anterior intrusion.

由于挤压不足或前部侵入导致的垂直维度偏离跟踪。

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Insufficient extrusion may manifest as uniform vacuoles emerging at the incisal edges or cusps and can be managed by removing the attachments on the off-tracking teeth and applying intra-/inter-maxillary elastics (Fig.

挤出不足可能表现为切缘或牙尖出现均匀的空泡，可以通过去除脱轨牙齿上的附件并应用颌内/颌间橡皮筋来管理（图。

10a

10a

). Alternatively, in cases of insufficient anterior intrusion, which manifest as inadequate correction of the anterior deep bite, auxiliary devices, such as implants or redesigning additional aligners to increase the staging design for tooth movement, may be added.

）。或者，在前牙内收不足的情况下，表现为前牙深覆合矫正不充分，可以添加辅助装置，如种植体或重新设计额外的矫治器以增加牙齿移动的阶段设计。

Off-tracking in the horizontal dimension commonly occurs in rotation correction, especially in severely rotated premolars.

水平维度上的偏离跟踪通常发生在旋转校正过程中，尤其是在严重旋转的前磨牙中。

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The removal of attachments and use of a power chain can be helpful in most cases (Fig.

在大多数情况下，去除附件并使用动力链会有所帮助（图。

10b

10b

).

）。

Off-tracking in the sagittal dimension is characterized by mesial inclination of the posterior teeth and torque loss of the anterior teeth (lingual inclination).

矢状面的偏离跟踪表现为后牙的近中倾斜和前牙的转矩丧失（舌向倾斜）。

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,

，

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Mismatches between the attachments and vacuoles on the aligners can be observed on mesially inclined posterior teeth, as well as the gaps between the mesial cups and aligners. Distal up-righting of these off-tracking teeth must be performed using intermaxillary elastics and/or sectional arch wires after the removal of the attachments (Fig.

在近中倾斜的后牙上可以观察到矫治器上的附件与空隙之间的不匹配，以及近中杯状结构与矫治器之间的间隙。这些偏离轨迹的牙齿必须在移除附件后，通过使用颌间牵引橡皮筋和/或片段弓丝进行远中直立。（图

.

。

10c, d

10c，d

).

）。

The loss of anterior tooth torque manifests as lingual inclination of the upper/lower anterior teeth, increased overbite, early contact of anterior teeth, and posterior open bite.

前牙转矩的丧失表现为上下前牙舌倾、覆牙合加深、前牙早接触以及后牙开牙合。

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In such cases, the aligners may need to be redesigned to restart the program.

在这种情况下，可能需要重新设计矫治器以重启治疗程序。

Fig. 9

图 9

Aligner off-tracking.

对齐偏离。

a

a

Off-tracking of upper incisors (yellow arrows).

上切牙偏离（黄色箭头）。

b

b

Off-tracking of a lower incisor (yellow arrow).

下切牙偏离（黄色箭头）。

c

c

Off-tracking of a lower canine and first premolar (yellow arrows).

下犬齿和第一前臼齿的偏离（黄色箭头）。

d

d

Off-tracking of an upper premolar (yellow arrow).

上前磨牙的偏离（黄色箭头）。

e

e

Off-tracking of an upper premolar and molar (yellow arrows).

上颌前磨牙和磨牙的偏离（黄色箭头）。

f

f

Off-tracking of a lower molar (yellow arrow)

下磨牙偏离（黄色箭头）

Full size image

全尺寸图像

Fig. 10

图10

Strategies for resolution of tooth off-tracking.

解决牙齿偏离的策略。

a

a

A “boot-strapping” technique was used to address the off-tracking of a lateral incisor by applying labial-lingual elastic traction.

使用了一种“引导”技术，通过施加唇舌向弹性牵引力来解决侧切牙的偏离问题。

b

b

A power chain was used to correct under-derotation of a second premolar.

使用了动力链来纠正第二前磨牙的旋转不足。

c

c

A vertical elastic traction from the upper premolar to the lower molar was implemented to correct mesial tipping and intrusion of the lower first molar.

实施了从上颌前磨牙到下颌磨牙的垂直弹性牵引，以纠正下颌第一磨牙的近中倾斜和内陷。

d

d

A segmental archwire technique was applied to correct mesial tipping of a lower second molar

应用片段弓丝技术矫正下颌第二磨牙的近中倾斜。

Full size image

全尺寸图像

Timing and considerations of program restart

程序重启的时机和注意事项

Sometimes not only one series of clear aligners are needed to complete the treatment. There are five possible reasons for this:

有时完成治疗不仅需要一系列的透明矫正器。对此有五个可能的原因：

The discrepancy between designed tooth movement and actual tooth movement, which result in an incomplete correction of the malocclusion, often occurring in some complex tooth movement, like intrusion, root control and more than 3 mm molar distalization. More series of aligners are designed to accomplish the treatment goal..

设计的牙齿移动与实际的牙齿移动之间的差异，导致错畸形未完全矫正，常发生在一些复杂的牙齿移动中，如压低、根控制和超过3毫米的磨牙远移。更多系列的矫治器被设计用于实现治疗目标。

Unwanted tooth movement occurs and leads to reduced occlusal contacts or even open bite in posterior segment, which may be due to the aligners’ effect of occlusal pad. More series of aligners are designed to consolidate the occlusion.

不希望发生的牙齿移动会导致后牙段咬合接触减少甚至开颌，这可能是由于矫治器的咬合垫效应所致。更多系列的矫治器被设计用来稳固咬合。

More teeth should be included into treatment, which is common in adolescents with erupting second molars. A new series of aligners are usually designed to cover these second molars and some heterotopic or impacted teeth, if any.

治疗中应包括更多的牙齿，这在第二磨牙正在萌出的青少年中很常见。通常会设计一系列新的矫正器来覆盖这些第二磨牙以及一些异位或阻生的牙齿（如果有）。

The change of occlusal relationship may occur, due to mandible growth and/or removal of occlusal interference. Then, a completely new design should be done according to the new and stable occlusal relationship.

由于下颌骨生长和/或咬合干扰的消除，咬合关系可能会发生变化。然后，应根据新的、稳定的咬合关系进行全新的设计。

Bad cooperation in patients, leads to serious off-tracking, and even totally unfitting. A new series of aligners are designed based on current status.

患者配合不佳，导致严重偏离，甚至完全不合适。根据当前情况设计了新的矫正器系列。

Treatment outcome

治疗结果

Treatment is complete after waring the final set of aligners, if the treatment objective has been achieved. The criteria for ending CAT are consistent with those for ending traditional fixed orthodontic treatment. At the end of the treatment, the attachments and other auxiliary devices are removed, and retainers are prescribed as usual..

在佩戴最后一副矫治器后，如果达到了治疗目标，则治疗完成。结束CAT（隐形矫治技术）的标准与结束传统固定正畸治疗的标准一致。在治疗结束时，去除附件及其他辅助装置，并按常规开具保持器。

Retention

保留

Retention is of vital importance to clear aligner treatment. Different modalities of retention can be chosen based on patient-specific characteristics, e.g., periodontal condition, caries vulnerability, etc. Patients should be recalled to check tooth alignment, retainer fitting, and signs of relapse..

保持对于透明矫正器治疗至关重要。可以根据患者特定的特征选择不同的保持方式，例如牙周状况、龋齿易感性等。应召回患者检查牙齿排列、保持器适配情况以及复发迹象。

Complications

并发症

CAT is associated with some risks to dental and periodontal health.

CAT 与一些牙齿和牙周健康风险相关。

Caries

龋齿

Poor oral hygiene during CAT can disrupt the oral microbiota, leading to white spot lesions or even caries.

CAT期间口腔卫生不良会破坏口腔微生物群，导致白斑病损甚至龋齿。

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However, compared to patients undergoing fixed orthodontic treatment, patients wearing clear aligners have lower levels of white spot lesions, total bacterial plaque, and cariogenic bacteria in the saliva.

然而，与接受固定正畸治疗的患者相比，佩戴透明矫正器的患者唾液中白斑病损、总菌斑和致龋细菌的水平较低。

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,

，

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,

，

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一百零一

This may be related to the reduced detrimental effect of clear aligners on oral hygiene.

这可能与透明矫治器对口腔卫生的不利影响减少有关。

Root resorption

根吸收

CAT may lead to root resorption. However, it reported that CAT applied a gentler force, resulting in a lower rate and severity of root resorption, compared to those observed in fixed orthodontic treatment.

CAT可能导致牙根吸收。然而，有报道称，与固定矫治器治疗相比，CAT施加的力较为温和，从而导致较低的牙根吸收率和严重程度。

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，

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Factors such as post-treatment root position (relationship with the cortical bone), extraction, tooth position, and specific tooth movement patterns (intrusion and extrusion) are all risk factors for root resorption, whereas post-treatment root position is most closely related to root resorption.

治疗后根尖位置（与皮质骨的关系）、拔牙、牙齿位置和特定的牙齿移动模式（内陷和外突）等因素都是根吸收的风险因素，而治疗后根尖位置与根吸收的关系最为密切。

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Therefore, reducing the risk of root resorption requires limiting root movement within cancellous bone and avoiding unnecessary reciprocal movement. Furthermore, a clear aligner design software with a root-bone system makes the root-bone relationship visible in the digital design, which helps reduce root resorption risks..

因此，降低根吸收的风险需要限制根在松质骨内的移动，并避免不必要的相互移动。此外，使用具有根-骨系统的透明矫正器设计软件可以在数字设计中使根-骨关系可视化，这有助于减少根吸收的风险。

Periodontal damage

牙周损伤

Standard orthodontic treatments do not cause periodontal damage. However, orthodontic appliances may increase the difficulty of maintaining oral hygiene, leading to a higher rate of gingivitis and periodontitis. Clinical trials have shown that, compared to fixed orthodontic appliances, clear aligners are more favorable for maintaining periodontal health in patients..

标准正畸治疗不会导致牙周损害。然而，正畸装置可能增加口腔卫生维护的难度，从而导致牙龈炎和牙周炎的发生率升高。临床试验表明，与固定正畸装置相比，透明矫治器更有助于患者保持牙周健康。

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，

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，

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，

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Moreover, for cases with an unsatisfactory periodontal status, design changes can help mitigate these risks by decreasing the speed of tooth movement, reducing teeth coverage by aligners, and prolonging the wearing duration for each set of aligners. Thus, clear aligners are recommended for patients susceptible to gingivitis and/or periodontitis..

此外，对于牙周状况不佳的病例，设计变更可以通过降低牙齿移动速度、减少矫治器对牙齿的覆盖以及延长每套矫治器的佩戴时间来帮助减轻这些风险。因此，建议牙龈炎和/或牙周炎易感患者使用透明矫治器。

Meanwhile, alveolar bone defect (fenestration and dehiscence) is also a common complication of orthodontic treatment. A recent study found that the incidence of fenestration in patients treated with clear aligner and fixed appliance was 23.96% and 26.18%, respectively.

同时，牙槽骨缺损（开窗和裂开）也是正畸治疗中常见的并发症。近期一项研究发现，使用隐形矫治器和固定矫治器治疗的患者中，开窗的发生率分别为23.96%和26.18%。

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Another investigation also showed that non-extraction CAT was associated with increased presence of alveolar bone dehiscence and fenestration.

另一项调查还显示，非拔牙CAT与牙槽骨裂开和骨开窗的发生率增加有关。

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Thus, root-bone relationship should be considered and evaluated carefully, especially arch expansion is designed.

因此，应该仔细考虑和评估牙根与骨骼的关系，尤其是当设计牙弓扩展时。

Relapse

复发

After orthodontic treatment, relapse tends to occur because of incomplete remodeling of the periodontal tissues and muscular system. In the literature, relapse has been mainly linked to occlusal stability, types of tooth movement, root-bone relationships, and the balance of intraoral and extraoral muscle forces, with the type of orthodontic appliance used having minimal impact on relapse risk..

正畸治疗后，由于牙周组织和肌肉系统的改建不完全，容易发生复发。在文献中，复发主要与咬合稳定性、牙齿移动类型、牙根与骨的关系以及口内和口外肌肉力量的平衡有关，而使用的正畸矫治器类型对复发风险影响较小。

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The use of retainers and correction of oral bad habits (such as tongue-thrust swallowing, etc.) are currently considered the most effective measures for reducing relapse risk.

保持器的使用和口腔不良习惯（如舌推吞咽等）的纠正目前被认为是最有效的减少复发风险的措施。

Conclusion and expectation

结论与期望

The design of clear aligners continues to evolve, taking advantage of the novel materials and insights generated by global big data studies, leading to less difficulty in complex cases treatment, allowing more patients worldwide to achieve better treatment outcome by this technology. A novel clear aligner philosophy—biomechanics-guided, esthetics-driven, periodontium-supported and TMJ-compatible clear aligner therapy (BEPT-CAT)—may be applied in clinical practice to guide aligner treatment planning and execution.

透明牙套的设计不断发展，利用全球大数据研究产生的新材料和新见解，降低了复杂病例治疗的难度，使世界各地更多的患者通过这项技术获得更好的治疗效果。一种全新的透明牙套理念——生物力学引导、美学驱动、牙周支持和颞下颌关节相容的透明牙套疗法（BEPT-CAT）——可应用于临床实践，以指导牙套治疗计划的制定和执行。

Moreover, the possibility of tiny attachments or attachment-free designs may become feasible, further improve patients’ comfort and esthetics during treatment. In the future, individual dental practices may be equipped with devices that allow to 3D-print the elements of the novel designs, further increasing treatment personalization..

此外，微小附件或无附件设计的可能性可能会变得可行，进一步提高患者在治疗过程中的舒适度和美观性。未来，个体牙科诊所可能会配备允许3D打印新设计元素的设备，进一步增加治疗的个性化。

Advances in science and technology are driving progress in orthodontics. Esthetic, comfortable, convenient, and efficient orthodontic treatment will be realized through digitally oriented invisible aligner technology, bringing CAT into mainstream use.

科技进步正推动正畸学的发展。通过面向数字化的隐形矫治器技术，将实现美观、舒适、便捷和高效的正畸治疗，使计算机辅助设计治疗走向主流应用。

References

参考文献

Lai, W., Fang, B. & Li, X.

赖伟，方波，李霞

Invisalign Clear Aligner Technique

隐适美透明矫正技术

(People’s Medical Publishing House, 2023).

（人民卫生出版社，2023）。

Lombardo, G. et al. Worldwide prevalence of malocclusion in the different stages of dentition: a systematic review and meta-analysis.

伦巴多，G. 等。 不同牙列阶段错颌畸形的全球患病率：一项系统评价和荟萃分析。

Eur. J. Paediatr. Dent.

欧洲儿童牙科杂志

21

21

, 115–122 (2020).

，115-122页（2020年）。

CAS

中文名：化学文摘社

PubMed

PubMed

Google Scholar

谷歌学术

ElNaghy, R. & Hasanin, M. Impact of malocclusions on oral health-related quality of life among adolescents.

ElNaghy, R. & Hasanin, M. 错颌对青少年口腔健康相关生活质量的影响。

Evid. Based Dent.

基于证据的牙科学。

24

24

, 140–141 (2023).

，140-141页（2023年）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术

Goeranson, E. et al. Malocclusions and quality of life among adolescents: a systematic review and meta-analysis.

戈兰森，E. 等。青少年错颌畸形与生活质量：系统综述与荟萃分析。

Eur. J. Orthod.

欧洲正畸学杂志

45

45

, 295–307 (2023).

，295-307页（2023年）。

Article

文章

Google Scholar

谷歌学术索

Chen, M. et al. Impact of malocclusion on oral health-related quality of life in young adults.

陈，M. 等。错颌对年轻人口腔健康相关生活质量的影响。

Angle Orthod.

角度矫正。

85

85

, 986–991 (2015).

，986-991页（2015年）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术

Zhou, C. et al. Expert consensus on pediatric orthodontic therapies of malocclusions in children.

周，C. 等。儿童错颌畸形的儿科正畸治疗专家共识。

Int. J. Oral Sci.

国际口腔科学杂志

16

16

, 32 (2024).

，32（2024）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

AlMogbel, A. Clear aligner therapy: up to date review article.

阿尔莫格贝尔，A. 透明矫正器疗法：最新综述文章。

J. Orthod. Sci.

正畸科学杂志

12

12

, 37 (2023).

，37（2023）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Guo, F. et al. The impact of the COVID-19 epidemic on orthodontic patients in China: an analysis of posts on Weibo.

郭，F. 等。新冠疫情对中国正畸患者的影响：对微博帖子的分析。

Front. Med.

医学前沿

7

7

, 577468 (2020).

，577468（2020）。

Article

文章

Google Scholar

谷歌学术

Bichu, Y. M. et al. Advances in orthodontic clear aligner materials.

Bichu, Y. M. 等。正畸透明矫治器材料的进展。

Bioact. Mater.

生物活性材料

22

22

, 384–403 (2023).

，384-403页（2023年）。

PubMed

PubMed

Google Scholar

谷歌学术

Zhang, X. J. et al. Integrated three-dimensional digital assessment of accuracy of anterior tooth movement using clear aligners.

张晓军等。使用透明矫治器评估前牙移动准确性的综合三维数字化评估。

Korean J. Orthod.

韩国正畸学杂志

45

45

, 275–281 (2015).

，275-281页（2015年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Mao, B. et al. Expansion rebound deformation of clear aligners and its biomechanical influence: a three-dimensional morphologic analysis and finite element analysis study.

毛波等。透明矫治器的扩展回弹变形及其生物力学影响：一项三维形态分析与有限元分析研究。

Angle Orthod.

角度矫正。

93

93

, 572–579 (2023).

，572-579页（2023年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Xia, Q. et al. Comparative assessment of orthodontic clear aligner versus fixed appliance for anterior retraction: a finite element study.

夏, Q. 等。 正畸透明矫治器与固定矫治器前牙内收的对比评估：有限元研究。

BMC Oral. Health

BMC口腔健康

24

24

, 80 (2024).

，80（2024）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Liou, Y.-J. et al. Comparative assessment of orthodontic and aesthetic outcomes after orthognathic surgery with clear aligner or fixed appliance therapy.

刘，Y.-J. 等。正颌手术后使用隐形矫治器或固定矫治器的正畸与美学效果的比较评估。

Plast. Reconstr. Surg.

塑料重建外科

154

154

, 162–172 (2023).

，162-172页（2023年）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术索

Katib, H. S. et al. Stability and success of clear aligners in orthodontics: a narrative review.

Katib, H. S. 等。正畸中透明矫治器的稳定性和成功率：叙述性综述。

Cureus J. Med. Sci.

Cureus 医学科学期刊

16

16

, e52038 (2024).

，e52038（2024）。

Google Scholar

谷歌学术

Xia, Q. et al. Assessment of labially impacted canines traction mode with clear aligners vs. fixed appliance: a comparative study based on 3D finite element analysis.

夏, Q. 等。使用隐形矫治器与固定矫治器对唇侧阻生犬牙牵引模式的评估：基于3D有限元分析的比较研究。

Front. Bioeng. Biotechnol.

生物工程与生物技术前沿

10

10

, 1004223 (2022).

，1004223（2022）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Ma, Y. & Li, S. The optimal orthodontic displacement of clear aligner for mild, moderate and severe periodontal conditions: an in vitro study in a periodontally compromised individual using the finite element model.

马, Y. & 李, S. 针对轻度、中度和重度牙周状况的透明矫治器最佳正畸位移：一项使用有限元模型的体外研究。

BMC Oral Health

BMC口腔健康

21

21

, 109 (2021).

，109（2021）。

Article

文章

CAS

中国科学院

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Alam, M. K. et al. Future of orthodontics—a systematic review and meta-analysis on the emerging trends in this field.

阿拉姆，M. K. 等。正畸学的未来——关于该领域新兴趋势的系统综述与荟萃分析。

J. Clin. Med.

临床医学杂志

12

12

, 532 (2023).

，532页（2023年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Lynch, N. M. et al. Clear aligner therapy in the mixed dentition: indications and practitioner perspectives.

林奇，N. M. 等。混合牙列中的透明矫正器治疗：适应症与从业者视角。

Am. J. Orthod. Dentofac. Orthop.

美国正畸与牙面矫正杂志

164

164

, 172–182 (2023).

，172-182页（2023年）。

Article

文章

Google Scholar

谷歌学术

Meade, M. J., Ng, E. & Weir, T. Digital treatment planning and clear aligner therapy: a retrospective cohort study.

米德，M. J.，黄，E.，威尔，T. 数字化治疗规划与透明矫正器疗法：一项回顾性队列研究。

J. Orthod.

正畸学杂志

50

50

, 361–366 (2023).

，361-366页（2023年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Shrivastava, A. et al. Proficiency of clear aligner therapy: a systematic review and meta-analysis.

Shrivastava, A. 等。透明矫正器治疗的熟练程度：系统评价与荟萃分析。

Cureus

治愈

15

15

, e45072 (2023).

，e45072（2023）。

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Wang, X. & Gao, J. Clear aligner treatment assisted by mini screw for an adult with Class II division 2 malocclusion and a right upper canine completely outside of the dental arch: a case report.

王霞、高杰。使用微型螺钉辅助的透明矫正器治疗一位安氏II类2分类错颌畸形且右上犬齿完全位于牙弓外的成人病例报告。

Int. Orthod.

口腔正畸学国际版

22

22

, 100837 (2024).

，100837（2024）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术

Zhou, G. et al. Treatment of skeletal class III malocclusion using a combined clear aligner and surgery-early approach: assessment based on the American Board of Orthodontics Objective Grading System.

周，G. 等。使用联合隐形矫治器和早期手术方法治疗骨骼III类错颌：基于美国正畸委员会客观评分系统的评估。

J. Orofac. Orthop.

口腔正畸学杂志

85

85

, 359–367 (2023).

，359-367页（2023年）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术索

Rossini, G. et al. Efficacy of clear aligners in controlling orthodontic tooth movement: a systematic review.

罗西尼，G. 等。透明矫治器在控制正畸牙齿移动中的有效性：一项系统综述。

Angle Orthod.

角度矫正。

85

85

, 881–889 (2015).

，881-889页（2015年）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术

Shahabuddin, N., Kang, J. & Jeon, H. H. Predictability of the deep overbite correction using clear aligners.

沙哈布丁，N.，康，J.，全，H. H. 使用透明矫正器对深覆合矫正的可预测性。

Am. J. Orthod. Dentofac. Orthop.

美国正畸与牙面矫正杂志

163

163

, 793–801 (2023).

，793-801页（2023年）。

Article

文章

Google Scholar

谷歌学术

Tien, R. et al. The predictability of expansion with Invisalign: a retrospective cohort study.

田，R. 等。《Invisalign扩展的可预测性：一项回顾性队列研究》。

Am. J. Orthod. Dentofac. Orthop.

美国正畸与牙面矫正杂志

163

163

, 47–53 (2023).

，47-53页（2023年）。

Article

文章

Google Scholar

谷歌学术

Smith, J. M. et al. Predictability of lower incisor tip using clear aligner therapy.

Smith, J. M. 等。使用透明矫正器疗法预测下切牙倾斜度。

Prog. Orthod.

正畸进展

23

23

, 37 (2022).

，37（2022）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Cui, J.-Y. et al. Morphology changes of maxillary molar distalization by clear aligner therapy.

崔，J.-Y. 等。透明矫治器治疗上颌磨牙远移的形态变化。

Int. J. Morphol.

国际形态学杂志

40

40

, 920–926 (2022).

，920-926页（2022年）。

Article

文章

Google Scholar

谷歌学术

Long, H. et al. An objective system for appraising clear aligner treatment difficulty: clear aligner treatment complexity assessment tool (CAT-CAT).

龙，H. 等。一种客观评估透明矫正器治疗难度的系统：透明矫正器治疗复杂性评估工具（CAT-CAT）。

BMC Oral Health

BMC口腔健康

20

20

, 312 (2020).

，312页（2020年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Gómez-Aguirre, J. N. et al. Effects of interproximal enamel reduction techniques used for orthodontics: a systematic review.

戈麦斯-阿吉雷，J. N. 等。正畸使用的邻面釉质减少技术的效果：系统评价。

Orthod. Craniofac. Res.

正畸与颅面研究

25

25

, 304–319 (2022).

，304-319（2022）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术

Jaber, S. T., Hajeer, M. Y. & Sultan, K. Treatment effectiveness of clear aligners in correcting complicated and severe Malocclusion cases compared to fixed orthodontic appliances: a systematic review.

贾贝尔，S.T.，哈吉尔，M.Y.，苏丹，K. 透明矫正器与固定矫治器在治疗复杂和严重错颌病例中的疗效比较：一项系统综述。

Cureus

治愈

15

15

, e38311 (2023).

，e38311（2023）。

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Lapenaite, E. & Lopatiene, K. Interproximal enamel reduction as a part of orthodontic treatment.

莱佩奈特，E. & 洛帕蒂恩，K. 作为正畸治疗一部分的邻面釉质减少。

Stomatologija

牙科医学

16

16

, 19–24 (2014).

，19-24页（2014年）。

PubMed

PubMed

Google Scholar

谷歌学术搜索

Turner, S. et al. Orthodontic treatment for crowded teeth in children.

特纳，S. 等。儿童拥挤牙齿的正畸治疗。

Cochrane Database Syst. Rev.

Cochrane数据库系统综述

12

12

, Cd003453 (2021).

，Cd003453（2021）。

PubMed

PubMed

Google Scholar

谷歌学术索

Society of Orthodontics CSA. Guidelines for clear aligner orthodontic treatment (2021).

中华口腔医学会 orthodontics CSA。隐形矫治器正畸治疗指南（2021）。

Chin. J. Stomatol.

中国口腔医学杂志

56

56

, 983–988 (2021).

，983-988页（2021年）。

Google Scholar

谷歌学术

Mao, Z. et al. Evaluation of the impact of reference tooth morphology and alignment on model measurement accuracy.

毛，Z. 等。参考牙齿形态与排列对模型测量精度影响的评估。

Ann. Transl. Med.

中华医学翻译杂志

10

10

, 670 (2022).

，670（2022）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Wen, S. et al. Skeletal class II malocclusion management with clear aligners and mini-implants.

温，S. 等。使用透明矫正器和微种植体的骨骼II类错颌管理。

AJO-DO Clin. Companion

AJO-DO临床伴侣

(2024 in press).

（2024年，即将出版）。

Lione, R. et al. Maxillary arch development with Invisalign system.

Lione, R. 等。使用 Invisalign 系统的上颌弓发育。

Angle Orthod.

角度矫正。

91

91

, 433–440 (2021).

，第433-440页（2021年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Mohamed, R. N., Basha, S. & Al-Thomali, Y. Maxillary molar distalization with miniscrew-supported appliances in Class II malocclusion: a systematic review.

Mohamed, R. N., Basha, S. & Al-Thomali, Y. 使用微螺钉支撑装置进行上颌磨牙远中移动治疗II类错颌畸形：一项系统综述。

Angle Orthod.

角度矫正。

88

88

, 494–502 (2018).

，494-502页（2018年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Mahalakshmi, R. et al. Evaluation of horizontal distance between WALA-FA point in angle’s class I, class II, and class III malocclusion.

Mahalakshmi, R. 等。角度分类 I、II 和 III 错颌畸形中 WALA-FA 点之间水平距离的评估。

J. Pharm. Bioallied Sci.

药学与生物相关科学杂志

13

13

, S506–s509 (2021).

，S506–s509（2021）。

Article

文章

CAS

中国科学院

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Feştilă, D. et al. Testing the accuracy of Pont’s index in diagnosing maxillary transverse discrepancy as compared to the University of Pennsylvania CBCT analysis.

费什蒂拉，D. 等。测试Pont指数在诊断上颌横向差异时的准确性，与宾夕法尼亚大学CBCT分析进行比较。

Dent. J.

牙科杂志

10

10

, 23 (2022).

，23（2022）。

Article

文章

Google Scholar

谷歌学术

Nimbalkar, S. et al. Smile attractiveness related to buccal corridor space in 3 different facial types: a perception of 3 ethnic groups of Malaysians.

尼姆巴尔卡尔，S. 等。三种不同面部类型中颊侧走廊空间与微笑吸引力的关系：马来西亚三个种族群体的感知。

J. Prosthet. Dent.

《牙科修复学杂志》

120

120

, 252–256 (2018).

，252-256页（2018年）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术索

Arroyo Cruz, G. et al. Esthetic assessment of celebrity smiles.

阿罗约·克鲁兹，G. 等。名人微笑的美学评估。

J. Prosthet. Dent.

J. Prosthet. Dent. -> 《牙科修复学杂志》

125

125

, 146–150 (2021).

，146-150页（2021年）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术

Zhang, Y. et al. Effects of upper arch expansion using clear aligners on different stride and torque: a three-dimensional finite element analysis.

张烨等。使用透明矫治器进行上颌扩弓对不同步态和扭矩的影响：三维有限元分析。

BMC Oral Health

BMC口腔健康

23

23

, 891 (2023).

，891页（2023年）。

Article

文章

CAS

中国科学院

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Hong, K. et al. Efficient design of a clear aligner attachment to induce bodily tooth movement in orthodontic treatment using finite element analysis.

洪，K. 等。使用有限元分析高效设计正畸治疗中诱导整体牙移动的透明矫正器附件。

Materials

材料

14

14

, 4926 (2021).

，4926（2021）。

Article

文章

CAS

中国科学院

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Hui, V. L. Z. et al. Anatomical limitations and factors influencing molar distalization.

辉，V. L. Z. 等。磨牙远中移动的解剖限制及影响因素。

Angle Orthod.

角度矫正。

92

九十二

, 598–605 (2022).

，598-605页（2022年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Ravera, S. et al. Maxillary molar distalization with aligners in adult patients: a multicenter retrospective study.

Ravera, S. 等。成人患者使用隐形矫治器进行上颌磨牙远中移动的多中心回顾性研究。

Prog. Orthod.

进展性矫正治疗

17

17

, 12 (2016).

，12（2016）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Ozden, S., Uslu, F. & Dedeoglu, N. Evaluation of bone area in the posterior region for mandibular molar distalization in class I and class III patients.

奥兹登，S.，乌斯卢，F.，德德奥卢，N. I类和III类患者下颌磨牙远中移动的后部区域骨面积评估。

Clin. Oral. Investig.

临床口腔研究。

27

27

, 2041–2048 (2023).

，2041-2048（2023）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术

Colet, R. et al. Gingival recession in mandibular anterior teeth in patients with Class II malocclusion treated with elastics and Twin Force appliance.

科莱特，R. 等。使用弹性牵引和Twin Force矫治器治疗的II类错颌畸形患者下颌前牙的牙龈退缩。

Am. J. Orthod. Dentofac. Orthop.

美国正畸与牙面矫正杂志

162

162

, 529–537 (2022).

，529-537页（2022年）。

Article

文章

Google Scholar

谷歌学术

Gao, J. et al. Biomechanical effects of different staging and attachment designs in maxillary molar distalization with clear aligner: a finite element study.

高，J. 等。不同分期和附件设计在上颌磨牙远移中使用透明矫治器的生物力学效应：一项有限元研究。

Prog. Orthod.

正畸进展

24

24

, 43 (2023).

，43（2023）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Chen, X. et al. Factors influencing the efficacy of invisalign in molar distalization and tooth movement.

陈曦等。影响隐适美在磨牙远移和牙齿移动中效果的因素。

Front. Bioeng. Biotechnol.

生物工程与生物技术前沿

11

11

, 1215169 (2023).

，1215169（2023）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Castroflorio, T. et al. Predictability of orthodontic tooth movement with aligners: effect of treatment design.

卡斯特罗弗洛里奥，T. 等。隐形矫治器牙齿移动的可预测性：治疗设计的影响。

Prog. Orthod.

正畸进展

24

24

, 2 (2023).

，2（2023）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Liu, X. et al. Effects of upper-molar distalization using clear aligners in combination with Class II elastics: a three-dimensional finite element analysis.

刘翔等。使用透明矫治器结合II类牵引进行上颌磨牙远移的效果：三维有限元分析。

BMC Oral Health

BMC口腔健康

22

22

, 546 (2022).

，546页（2022年）。

Article

文章

CAS

中国科学院

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Kırcalı, M. & Yüksel, A. S. Evaluation of dentoalveolar and dentofacial effects of a mini-screw-anchored pendulum appliance in maxillary molar distalization.

Kırcalı, M. & Yücksel, A. S. 微螺钉锚定摆动矫治器在上颌磨牙远移中的牙槽及颌面效应评估。

Turk. J. Orthod.

土耳其正畸学杂志

31

31

, 103–109 (2018).

，103-109页（2018年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Amasyalı, M., Sabuncuoğlu, F. A. & Oflaz, U. Intraoral molar distalization with intraosseous mini screw.

阿马西亚利，M.，萨邦丘奥卢，F. A. & 奥夫拉兹，U. 使用骨内微型螺钉的口腔内磨牙远中移动。

Turk. J. Orthod.

土耳其正畸学杂志

31

31

, 26–30 (2018).

，26-30页（2018年）。

PubMed

PubMed

Google Scholar

谷歌学术索

Guo, R. et al. Biomechanical analysis of miniscrew-assisted molar distalization with clear aligners: a three-dimensional finite element study.

郭，R. 等。使用透明矫治器进行微螺钉辅助磨牙远移的生物力学分析：一项三维有限元研究。

Eur. J. Orthod.

欧洲正畸学杂志

46

46

, cjad077 (2024).

，cjad077（2024）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术

Yan, X. et al. Effectiveness of clear aligners in achieving proclination and intrusion of incisors among Class II division 2 patients: a multivariate analysis.

严翔等。透明矫治器在实现II类2分类错颌患者前牙唇倾和内收方面的有效性：多元分析。

Prog. Orthod.

正畸进展

24

24

, 12 (2023).

，12（2023）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Mao, B. et al. The effect of maxillary molar distalization with clear aligner: a 4D finite-element study with staging simulation.

毛，B. 等。使用透明矫治器进行上颌磨牙远中移动的效果：具有分期模拟的四维有限元研究。

Prog. Orthod.

正畸进展

24

24

, 16 (2023).

，16（2023）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Liu, X. et al. Effective contribution ratio of the molar during sequential distalization using clear aligners and micro-implant anchorage: a finite element study.

刘晓明等。使用隐形矫治器和微种植体支抗在顺序远移过程中磨牙的有效贡献率：一项有限元研究。

Prog. Orthod.

进展性矫正治疗

24

24

, 35 (2023).

，35（2023）。

Article

文章

CAS

中国科学院

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Mao, B. et al. Effect of different anchorage reinforcement methods on long-term maxillary whole arch distalization with clear aligner: a 4D finite element study with staging simulation.

毛波等。不同支抗加固方法对使用透明矫治器进行上颌全牙弓长期远移的影响：具有分期模拟的四维有限元研究。

Bioengineering

生物工程

11

11

, 3 (2023).

，3（2023）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Zheng, X. et al. Implants for orthodontic anchorage: an overview.

郑，X. 等。正畸支抗种植体：概述。

Medicine

医学

97

97

, e0232 (2018).

，e0232（2018）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Drummond, S. & Capelli, J. Jr. Incisor display during speech and smile: age and gender correlations.

Drummond, S. & Capelli, J. Jr. 说话和微笑时切牙的显露：年龄与性别的相关性。

Angle Orthod.

角度矫正。

86

86

, 631–637 (2016).

，631-637页（2016年）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术索

Singh, A. V. et al. Evaluation of change in the facial profile and aesthetics in relation to incisor position in both maxillary and mandibular arches.

辛格，A. V. 等。评估与上颌和下颌弓切牙位置相关的面部轮廓和美学变化。

Cureus

治愈

15

15

, e34403 (2023).

，e34403（2023）。

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Zhang, K. et al. Effects of transverse relationships between maxillary arch, mouth, and face on smile esthetics.

张凯等。上颌弓、口腔和面部的横向关系对微笑美学的影响。

Angle Orthod.

角度矫正。

86

86

, 135–141 (2016).

，135-141页（2016年）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术

Cao, L. et al. Effect of maxillary incisor labiolingual inclination and anteroposterior position on smiling profile esthetics.

曹，L. 等。上切牙唇舌侧倾斜及前后位置对微笑轮廓美学的影响。

Angle Orthod.

角度矫正。

81

81

, 121–129 (2011).

，121-129页（2011年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Feres, M. F. N. et al. Comparative tomographic study of the maxillary central incisor collum angle between Class I, Class II, division 1 and 2 patients.

费雷斯，M. F. N. 等。第一类、第二类，1型和2型患者上颌中切牙颈倾角的比较断层研究。

J. Orthod. Sci.

口腔科学杂志

7

7

, 6 (2018).

，6（2018）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Li, Y. et al. Stress and movement trend of lower incisors with different IMPA intruded by clear aligner: a three-dimensional finite element analysis.

李烨等。不同IMPA值的下切牙在透明矫治器作用下的应力和移动趋势：三维有限元分析。

Prog. Orthod.

正畸学进展

24

24

, 5 (2023).

，5（2023）。

Article

文章

CAS

中国科学院

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Yu, Q. et al. The association between lower incisal inclination and morphology of the supporting alveolar bone-a cone-beam CT study.

余青等。下切牙倾斜度与支持性牙槽骨形态之间的关联——一项锥形束CT研究。

Int. J. Oral Sci.

国际口腔科学杂志

1

1

, 217–223 (2009).

，217-223页（2009年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Cheng, Y. et al. The three-dimensional displacement tendency of teeth depending on incisor torque compensation with clear aligners of different thicknesses in cases of extraction: a finite element study.

程昱等。不同厚度的透明矫治器在拔牙病例中对切牙转矩补偿依赖的三维牙齿位移趋势：有限元研究。

BMC Oral Health

BMC口腔健康

22

22

, 499 (2022).

，499页（2022年）。

Article

文章

CAS

中国科学院

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Dahhas, F. Y. et al. The role of interproximal reduction (IPR) in clear aligner therapy: a critical analysis of indications, techniques, and outcomes.

达哈斯，F. Y. 等。邻面去釉（IPR）在隐形矫治器治疗中的作用：对适应症、技术及结果的批判性分析。

Cureus

治愈

16

16

, e56644 (2024).

，e56644（2024）。

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Jarjoura, K., Gagnon, G. & Nieberg, L. Caries risk after interproximal enamel reduction.

Jarjoura, K., Gagnon, G. & Nieberg, L. 邻面釉质减径后的龋齿风险。

Am. J. Orthod. Dentofac. Orthop.

美国正畸与牙面矫正杂志

130

一百三十

, 26–30 (2006).

，26-30页（2006年）。

Article

文章

Google Scholar

谷歌学术索

Koretsi, V., Chatzigianni, A. & Sidiropoulou, S. Enamel roughness and incidence of caries after interproximal enamel reduction: a systematic review.

科雷茨，V.，查齐吉安尼，A.，& 西迪罗普卢，S. 邻面釉质减径后釉质粗糙度与龋齿发生率：一项系统综述。

Orthod. Craniofac. Res.

正畸与颅面研究

17

17

, 1–13 (2014).

，1–13（2014）。

Article

文章

CAS

中国科学院

PubMed

PubMed

Google Scholar

谷歌学术

Zawawi, K. H. Orthodontic treatment of a mandibular incisor extraction case with invisalign.

扎瓦维，K. H. 使用隐适美治疗下颌切牙拔除病例的正畸治疗。

Case Rep. Dent.

牙科病例报告

2014

2014年

, 657657 (2014).

，657657（2014）。

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Giancotti, A., Garino, F. & Mampieri, G. Lower incisor extraction treatment with the Invisalign® technique: three case reports.

詹科蒂，A.，加里诺，F. & 曼皮耶里，G. 使用Invisalign®技术进行下切牙拔除治疗：三个病例报告。

J. Orthod.

正畸学杂志

42

42

, 33–44 (2015).

，33-44页（2015年）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术

Xing, X. et al. Asymmetric extraction treatment in a middle-aged patient with dental crowding and protrusion using clear aligners.

邢晓等。使用透明矫治器对中年牙列拥挤和前突患者进行非对称拔牙治疗。

Case Rep. Dent.

牙科病例报告

2023

2023

, 8836409 (2023).

，8836409（2023）。

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Ren, L. et al. The predictability of orthodontic tooth movements through clear aligner among first-premolar extraction patients: a multivariate analysis.

任，L. 等。通过隐形矫治器对第一前磨牙拔除患者的正畸牙齿移动的可预测性：多元分析。

Prog. Orthod.

正畸进展

23

23

, 52 (2022).

，52（2022）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Dai, F. F., Xu, T. M. & Shu, G. Comparison of achieved and predicted tooth movement of maxillary first molars and central incisors: first premolar extraction treatment with Invisalign.

戴，F. F.，徐，T. M.，舒，G. 上颌第一磨牙和中切牙的实现与预测牙齿移动的比较：使用Invisalign进行的第一前磨牙拔除治疗。

Angle Orthod.

角度矫正。

89

89

, 679–687 (2019).

，679-687页（2019年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Jin, X. et al. The effect of enhanced structure in the posterior segment of clear aligners during anterior retraction: a three-dimensional finite element and experimental model analysis.

金，X. 等。前牙后缩过程中透明矫治器后段结构增强的效果：三维有限元与实验模型分析。

Prog. Orthod.

正畸进展

25

25

, 3 (2024).

，3（2024）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Cheng, Y. et al. Torque movement of the upper anterior teeth using a clear aligner in cases of extraction: a finite element study.

程昱等。使用隐形矫治器在拔牙病例中对上切牙施加扭矩移动的有限元研究。

Prog. Orthod.

正畸进展

23

23

, 26 (2022).

，26（2022）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Liu, L. et al. The effects of aligner overtreatment on torque control and intrusion of incisors for anterior retraction with clear aligners: a finite-element study.

刘，L. 等。对齐器过度治疗对前牙后移时切牙转矩控制和压低的影响：一项有限元研究。

Am. J. Orthod. Dentofac. Orthop.

美国正畸与牙面矫正杂志

162

162

, 33–41 (2022).

，33-41页（2022年）。

Article

文章

Google Scholar

谷歌学术

Wang, S. et al. Effects of overtreatment with different attachment positions on maxillary anchorage enhancement with clear aligners: a finite element analysis study.

王松等。不同附件位置过度治疗对透明矫治器上颌支抗增强效果的影响：有限元分析研究。

BMC Oral. Health

BMC口腔健康

23

23

, 693 (2023).

，693页（2023年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Dahhas, F. Y. et al. The potency of Invisalign® in Class II malocclusion in adults: a narrative review.

达哈斯，F. Y. 等。Invisalign® 在成人 II 类错颌畸形中的潜力：叙述性综述。

Cureus

Cureus

15

15

, e49664 (2023).

，e49664（2023）。

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Lai, E. H. et al. Three-dimensional dental model analysis of treatment outcomes for protrusive maxillary dentition: comparison of headgear, miniscrew, and miniplate skeletal anchorage.

赖，E. H. 等。前突上颌牙列治疗结果的三维牙模分析：头帽、微螺钉和微型骨板骨骼锚定的比较。

Am. J. Orthod. Dentofac. Orthop.

美国正畸与牙面矫正杂志

134

134

, 636–645 (2008).

，636-645页（2008年）。

Article

文章

Google Scholar

谷歌学术

Long, H., Han, X. & Lai, W.

龙，韩，赖

Clinical Insertion Techniques of Orthodontic Temporary Anchorage Devices

正畸临时支抗装置的临床植入技术

(Wiley & Blackwell, 2024).

（威利与布莱克威尔，2024）。

Wu, Y. et al. Does mandibular advancement with clear aligners have the same skeletal and dentoalveolar effects as traditional functional appliances?

吴烨等。使用透明矫治器的下颌前移是否与传统功能性矫治器具有相同的骨骼和牙槽效应？

BMC Oral Health

BMC口腔健康

23

23

, 65 (2023).

，65（2023）。

Article

文章

CAS

中国科学院

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Sun, Z. et al. Comparison of cephalometric measurements of the Twin Block and A6 appliances in the treatment of Class II malocclusion: a retrospective comparative cohort study.

孙，Z. 等。Twin Block 和 A6 矫治器在治疗 II 类错颌中的头影测量比较：一项回顾性比较队列研究。

Ann. Transl. Med.

安。翻译。医学。

10

10

, 876 (2022).

，876页（2022年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术搜索

Gurgel, M. L. et al. Clear aligner mandibular advancement in growing patients with Class II malocclusion.

Gurgel, M. L. 等。生长发育期II类错颌畸形患者的透明矫治器下颌前移。

AJO DO Clin. Companion

AJO DO临床伴侣

3

3

, 93–109 (2023).

，93-109页（2023年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术搜索

Yu, L. et al. Mandibular advancement with clear aligners and functional appliances in the treatment of skeletal Class II malocclusion: a systematic review and meta-analysis.

Yu, L. 等。使用透明矫正器和功能性矫治器进行下颌前移治疗骨骼II类错颌畸形：系统综述与荟萃分析。

Hua Xi Kou Qiang Yi Xue Za Zhi

华西口腔医学杂志

41

41

, 305–314 (2023).

，305-314（2023）。

PubMed

PubMed

Google Scholar

谷歌学术

Timm, L. H. et al. Factors influencing patient compliance during clear aligner therapy: a retrospective cohort study.

蒂姆，L. H. 等。影响患者在透明矫治器治疗期间依从性的因素：一项回顾性队列研究。

J. Clin. Med.

临床医学杂志

10

10

, 3103 (2021).

，3103（2021）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Kim, J. E., Kim, S. & Kim, D. H. Comparison of oral health status, oral hygiene management behaviours and satisfaction of patients with fixed orthodontic appliance and clear aligner: a quasi-experimental design.

金，J. E.，金，S.，金，D. H. 固定矫治器和隐形矫治器患者的口腔健康状况、口腔卫生管理行为及满意度比较：一项准实验设计。

Int. J. Dent. Hyg.

国际牙科卫生杂志

22

22

, 939–948 (2024).

，939-948页（2024年）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术

Hansa, I. et al. Outcomes of clear aligner treatment with and without dental monitoring: a retrospective cohort study.

汉萨，I. 等。有无牙科监测的透明矫正器治疗结果：一项回顾性队列研究。

Am. J. Orthod. Dentofac. Orthop.

美国正畸与牙面矫正杂志

159

159

, 453–459 (2021).

，453-459页（2021年）。

Article

文章

Google Scholar

谷歌学术索

Uzunçıbuk, H. et al. Prevalence of temporomandibular disorders in clear aligner patients using orthodontic intermaxillary elastics assessed with diagnostic criteria for temporomandibular disorders (DC/TMD) axis II evaluation: a cross-sectional study.

乌尊奇布克，H. 等。使用正畸颌间橡皮筋的透明矫正器患者中颞下颌关节紊乱病的患病率——通过颞下颌关节紊乱病诊断标准 (DC/TMD) 轴 II 评估：一项横断面研究。

J. Oral Rehabil.

口腔康复杂志

51

51

, 500–509 (2024).

，500-509页（2024年）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术

Gurbanov, V., Bas, B. & Öz, A. A. Evaluation of stresses on temporomandibular joint in the use of Class II and III orthodontic elastics: a three-dimensional finite element study.

Gurbanov, V., Bas, B. & Öz, A. A. 使用II类和III类正畸橡皮筋时对颞下颌关节应力的评估：一项三维有限元研究。

J. Oral Maxillofac. Surg.

口腔颌面外科杂志

78

78

, 705–716 (2020).

，705-716页（2020年）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术索

Zhang, Y. et al. Numerical investigation of the biomechanical effects of orthodontic intermaxillary elastics on the temporomandibular joint.

张, Y. 等。正畸用颌间弹性对颞下颌关节生物力学效应的数值研究。

J. Mech. Behav. Biomed. Mater.

机械行为与生物医学材料杂志

141

141

, 105764 (2023).

，105764（2023）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术

Liu, J. Q. et al. Associations among orthodontic history, psychological status, and temporomandibular-related quality of life: a cross-sectional study.

刘，J. Q. 等。正畸史、心理状态与颞下颌关节相关生活质量的关联：一项横断面研究。

Int. J. Clin. Pr.

国际临床实践杂志

2022

2022

, 3840882 (2022).

，3840882（2022）。

Google Scholar

谷歌学术

Yaosen, C. et al. Risk factors of composite attachment loss in orthodontic patients during orthodontic clear aligner therapy: a prospective study.

姚森，C. 等。正畸透明矫正器治疗期间正畸患者复合附着丧失的危险因素：一项前瞻性研究。

Biomed. Res. Int.

生物医学研究国际

2021

2021

, 6620377 (2021).

，6620377（2021）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Groody, J. T. et al. Effect of clear aligner attachment design on extrusion of maxillary lateral incisors: a multicenter, single-blind randomized clinical trial.

Groody, J. T. 等。透明矫治器附件设计对上颌侧切牙伸长的影响：一项多中心、单盲随机临床试验。

Am. J. Orthod. Dentofac. Orthop.

美国正畸与牙面矫正杂志

164

164

, 618–627 (2023).

，618-627（2023）。

Article

文章

Google Scholar

谷歌学术

Ferlias, N. et al. In vitro comparison of different Invisalign® and 3Shape® attachment shapes to control premolar rotation.

费里亚斯，N. 等。体外比较不同Invisalign®和3Shape®附件形状对前磨牙旋转的控制。

Front. Bioeng. Biotechnol.

生物工程与生物技术前沿

10

10

, 840622 (2022).

，840622（2022）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Ma, X. Q. et al. [Clinical efficacy of the combination of miniscrew with clear aligner in controlling the roller coaster effect].

马晓晴等。[微螺钉与透明矫治器联合应用控制过山车效应的临床疗效]。

Shanghai Kou Qiang Yi Xue

上海口腔医学

31

31

, 193–197 (2022).

，193-197页（2022年）。

PubMed

PubMed

Google Scholar

谷歌学术

Song, Z. et al. Microbiome and metabolome associated with white spot lesions in patients treated with clear aligners.

宋，Z. 等。与使用透明矫正器治疗的患者白斑病变相关的微生物组和代谢组。

Front. Cell Infect. Microbiol.

前言。细胞感染微生物学。

13

13

, 1119616 (2023).

，1119616（2023）。

Article

文章

CAS

中国科学院

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Raghavan, S. et al. White spot lesions, plaque accumulation and salivary caries-associated bacteria in clear aligners compared to fixed orthodontic treatment. A systematic review and meta-analysis.

Raghavan, S. 等。透明矫治器与固定正畸治疗相比的白斑病变、菌斑堆积和唾液相关龋齿细菌：系统综述与荟萃分析。

BMC Oral Health

BMC口腔健康

23

23

, 599 (2023).

，599页（2023年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Malhi, G. Clear aligners vs fixed appliances: which treatment option presents a higher incidence of white spot lesions, plaque accumulation and salivary caries-associated bacteria?

Malhi, G. 透明矫正器与固定矫治器：哪种治疗选项呈现更高的白斑病变、菌斑堆积和唾液龋齿相关细菌的发生率？

Evid. Based Dent.

基于证据的牙科学

25

25

, 21–22 (2024).

，21-22页（2024）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术索

Guo, R. et al. Profiling of subgingival plaque biofilm microbiota in female adult patients with clear aligners: a three-month prospective study.

郭，R. 等。成年女性透明矫治器患者龈下菌斑生物膜微生物群的分析：一项为期三个月的前瞻性研究。

PeerJ

同行评审期刊

6

6

, e4207 (2018).

，e4207（2018）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术搜索

Fang, X., Qi, R. & Liu, C. Root resorption in orthodontic treatment with clear aligners: a systematic review and meta-analysis.

方祥、齐荣、刘畅。《使用透明矫正器的正畸治疗中的牙根吸收：系统评价与荟萃分析》。

Orthod. Craniofac. Res.

正畸与颅面研究

22

22

, 259–269 (2019).

，259-269页（2019年）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术搜索

Withayanukonkij, W. et al. Root resorption during maxillary molar intrusion with clear aligners: a randomized controlled trial.

Withayanukonkij, W. 等。使用透明矫正器进行上颌磨牙压低过程中的牙根吸收：一项随机对照试验。

Angle Orthod.

角度矫正。

93

93

, 629–637 (2023).

，629-637页（2023年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Yi, J. et al. External apical root resorption in non-extraction cases after clear aligner therapy or fixed orthodontic treatment.

易, J. 等。 非拔牙病例在透明矫正器治疗或固定正畸治疗后的外部根尖吸收。

J. Dent. Sci.

牙科学杂志

13

13

, 48–53 (2018).

，48-53页（2018年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Zheng, W. et al. The osteoclastic activity in apical distal region of molar mesial roots affects orthodontic tooth movement and root resorption in rats.

郑，W. 等。磨牙近中根尖远端区域的破骨细胞活动影响大鼠的正畸牙齿移动和牙根吸收。

Int. J. Oral Sci.

国际口腔科学杂志

16

16

, 19 (2024).

，19（2024）。

Article

文章

CAS

中国科学院

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Liu, W. et al. Volumetric cone-beam computed tomography evaluation and risk factor analysis of external apical root resorption with clear aligner therapy.

刘, W. 等。 使用清晰矫正器治疗的外部根尖吸收的体积锥形束计算机断层扫描评估与风险因素分析。

Angle Orthod.

角度矫正。

91

91

, 597–603 (2021).

，597-603（2021）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术索

Jiang, Q. et al. Periodontal health during orthodontic treatment with clear aligners and fixed appliances: a meta-analysis.

姜，Q. 等。使用隐形矫治器和固定矫治器进行正畸治疗期间的牙周健康：一项荟萃分析。

J. Am. Dent. Assoc.

美国牙科协会杂志

149

149

, 712–720.e712 (2018).

，712-720.e712（2018）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术

Shokeen, B. et al. The impact of fixed orthodontic appliances and clear aligners on the oral microbiome and the association with clinical parameters: a longitudinal comparative study.

Shokeen, B. 等。固定矫治器和透明对齐器对口腔微生物组的影响及其与临床参数的关联：一项纵向比较研究。

Am. J. Orthod. Dentofac. Orthop.

美国正畸与牙面矫正杂志

161

161

, e475–e485 (2022).

，e475–e485（2022）。

Article

文章

Google Scholar

谷歌学术

Chen, M. et al. Sequential soft- and hard-tissue augmentation after clear aligner-mediated adjustment of traumatic occlusion: a case report.

陈，M. 等。透明矫治器调整创伤性咬合后的序贯软硬组织增量：病例报告。

J. Am. Dent. Assoc.

美国牙科协会杂志

153

153

, 572–581.e571 (2022).

，572-581.e571（2022）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术索

Rouzi, M. et al. Impact of clear aligners on oral health and oral microbiome during orthodontic treatment.

鲁齐，M. 等。透明矫治器在正畸治疗期间对口腔健康和口腔微生物组的影响。

Int. Dent. J.

国际牙科杂志

73

73

, 603–611 (2023).

，603-611页（2023年）。

Article

文章

PubMed

PubMed

PubMed Central

PubMed Central

Google Scholar

谷歌学术

Guo, Z. et al. A retrospective study of alveolar bone remodelling after anterior retraction in orthodontic tooth extraction cases with clear aligners and fixed appliances.

郭，Z. 等。透明矫治器与固定矫治器在正畸拔牙病例中前牙后移后牙槽骨改建的回顾性研究。

Orthod. Craniofac. Res.

正畸与颅面研究

27

27

, 220–227 (2024).

，220-227页（2024年）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术

Allahham, D. O. et al. Association between nonextraction clear aligner therapy and alveolar bone dehiscences and fenestrations in adults with mild-to-moderate crowding.

阿拉哈姆，D. O. 等。非拔牙透明矫正器治疗与成人轻中度拥挤的牙槽骨开裂和骨开窗之间的关联。

Am. J. Orthod. Dentofac. Orthop.

美国正畸与牙面矫正杂志

163

163

, 22–36 (2023).

，22-36页（2023年）。

Article

文章

Google Scholar

谷歌学术

Littlewood, S. J., Kandasamy, S. & Huang, G. Retention and relapse in clinical practice.

Littlewood, S. J., Kandasamy, S. & Huang, G. 临床实践中的保留与复发。

Aust. Dent. J.

澳大利亚牙科杂志

62

62

, 51–57 (2017).

，51-57页（2017年）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术索

Porwal, A. & Sasaki, K. Current status of the neutral zone: a literature review.

Porwal, A. & Sasaki, K. 中性区的现状：文献综述。

J. Prosthet. Dent.

《牙科修复学杂志》

109

109

, 129–134 (2013).

，129-134页（2013年）。

Article

文章

PubMed

PubMed

Google Scholar

谷歌学术

Johnston, C. D. & Littlewood, S. J. Retention in orthodontics.

约翰斯顿，C. D. & 利特尔伍德，S. J. 正畸学中的保持。

Br. Dent. J.

英国牙科杂志

218

218

, 119–122 (2015).

，119-122页（2015年）。

Article

文章

CAS

中国科学院

PubMed

PubMed

Google Scholar

谷歌学术索

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Acknowledgements

致谢

Special thanks are extended to Professor Xuedong Zhou for her kind support in fostering the development of clear aligner technique in our dental school and her helpful guidance on this work.

特别感谢周学东教授对我校牙科清晰矫治器技术发展的大力支持以及对这项工作的有益指导。

Author information

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Authors and Affiliations

作者与所属机构

State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China

口腔疾病国家重点实验室，国家口腔医学中心，国家口腔疾病临床研究中心，四川大学华西口腔医院正畸科，中国成都

Yan Wang, Hu Long, Zhihe Zhao, Ding Bai, Xianglong Han, Jun Wang & Wenli Lai

王艳，龙虎，赵志和，白丁，韩向龙，王俊，赖文莉

Department of Orthodontics, Ninth People’s Hospital Affiliated to School of Medicine, Shanghai Jiaotong University, Shanghai, China

中国上海交通大学医学院附属第九人民医院口腔正畸科

Bing Fang

冰芳

School of Stomatology, Department of Orthodontics, The Fourth Military Medical University, Xi’an, China

中国西安第四军医大学口腔医学院正畸科

Zuolin Jin

金左林

State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China

口腔颌面重建与再生国家重点实验室，教育部口腔生物医学重点实验室，湖北省口腔医学重点实验室，武汉大学口腔医学院，中国武汉

Hong He

红河

Department of Orthodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China

中国北京首都医科大学口腔医学院北京口腔医院正畸科

Yuxin Bai

白宇欣

Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, China.

中国北京：北京大学口腔医学院·口腔医院正畸科、国家口腔医学中心、国家口腔疾病临床医学研究中心、口腔生物材料和数字诊疗装备国家工程研究中心、北京市数字化口腔医学重点实验室、国家卫生健康委员会数字化口腔医学重点实验室、国家药品监督管理局口腔材料重点实验室。

Weiran Li

李伟然

Department of Orthodontics, School and Hospital of Stomatology, Jilin University, Changchun, China

中国吉林大学口腔医学院附属口腔医院正畸科

Min Hu

胡敏

Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China

中国北京清华大学临床医学院北京清华长庚医院

Yanheng Zhou

周彦衡

Department of Stomatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

中国广州中山大学附属第三医院口腔科

Hong Ai

洪爱

Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China

中国上海，复旦大学附属口腔医院正畸科 & 口腔医学院，上海市颅颌面发育与疾病重点实验室

Yuehua Liu

刘月华

Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China

中国广州，中山大学光华口腔医学院附属口腔医院，广东省口腔医学重点实验室

Yang Cao

曹阳

Department of Stomatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

浙江大学医学院附属第一医院口腔科，杭州，中国

Jun Lin

林俊

Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China

中国南京大学医学院附属口腔医院，南京

Huang Li

黄丽

Department of Orthodontics, School and Hospital of Stomatology, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China.

山东大学口腔医学院及附属口腔医院正畸科，山东省口腔组织再生重点实验室，山东省口腔材料与口腔组织再生工程实验室，山东省口腔疾病临床研究中心，中国济南。

Jie Guo

郭杰

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Contributions

贡献

Conceptualization and investigation: W.L. and Z.Z.; Supervision: W.L. and D.B.; Original draft: Y.W. and H.L.; Review & editing: X.H., J.W., B.F., Z.J., H.H., Y.B., W.L., M.H., Y.Z., H.A., Y.L., Y.C., J.L., H.L., and J.G.

概念化与调查：W.L. 和 Z.Z.；监督：W.L. 和 D.B.；原始草案：Y.W. 和 H.L.；审阅与编辑：X.H.、J.W.、B.F.、Z.J.、H.H.、Y.B.、W.L.、M.H.、Y.Z.、H.A.、Y.L.、Y.C.、J.L.、H.L. 和 J.G.

Corresponding author

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赖文丽

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Wang, Y., Long, H., Zhao, Z.

王, Y., 龙, H., 赵, Z.

et al.

等人

Expert consensus on the clinical strategies for orthodontic treatment with clear aligners.

关于使用透明矫治器进行正畸治疗的临床策略的专家共识。

Int J Oral Sci

国际口腔科学杂志

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17

, 19 (2025). https://doi.org/10.1038/s41368-025-00350-2

，19（2025）。https://doi.org/10.1038/s41368-025-00350-2

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DOI

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https://doi.org/10.1038/s41368-025-00350-2

https://doi.org/10.1038/s41368-025-00350-2

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Subjects

主题

Craniofacial orthodontics

颅面正畸学

Malocclusion

错颌畸形