Article Data

  • Views 1004
  • Dowloads 280

Original Research

Open Access Special Issue

The predictability of arch expansion with the Invisalign First system in children with mixed dentition: a retrospective study

  • Chi Hoon Kim1
  • Sang-Jin Moon2
  • Chung-Min Kang1
  • Je Seon Song1,*,

1Department of Pediatric Dentistry, College of Dentistry, Yonsei University, 03722 Seoul, Republic of Korea

2Yongin Junior Dental Clinic, 17051 Yongin, Republic of Korea

DOI: 10.22514/jocpd.2024.012 Vol.48,Issue 1,January 2024 pp.91-100

Submitted: 26 June 2023 Accepted: 09 August 2023

Published: 03 January 2024

(This article belongs to the Special Issue New technologies and materials in clinical pediatric dentistry)

*Corresponding Author(s): Je Seon Song E-mail:


This study aimed to quantify the predictability of arch expansion in children with early mixed dentition treated with the Invisalign First® system and evaluate the clinical factors for the predictability of arch expansion. Pretreatment, predicted and posttreatment digital models from Invisalign’s ClinCheck® software were obtained for 90 children with mean (standard deviation) age of 8.42 (0.93) who planned arch expansion. Arch width measurements were collected using Invisalign’s arch width table. The predictability of expansion was calculated by comparing the amount of expansion achieved with the predicted expansion. Linear regression analysis was used to evaluate clinical factors associated with predictability of expansion. The predictability of the expansion of the maxillary teeth was as follows: 71.1% primary canines (n = 55), 67.5% first primary molars (n = 46), 65.2% second primary molars (n = 79), and 53.4% first permanent molars (n = 90); the predictability of the expansion of the mandibular teeth was 81.1%primary canines (n = 31), 81.2% first primary molars (n = 51), 77.8% second primary molars (n = 80), and 69.4% first permanent molars (n = 90). The predictability of arch expansion was significantly higher in the mandibular arch compared to the maxillary arch and significantly lower in the permanent first molar than in the other primary teeth. Predictability decreased significantly as the amount of predicted expansion per aligner increased in the upper and lower permanent first molars, primary second molars, and upper primary canines. Predictability significantly increased when buccal or palatal attachments were placed on the bilateral side compared to cases without attachment at the upper permanent first and primary second molars. The predictability of arch expansion using the Invisalign First® system varies according to arch and tooth type. The amount of predicted expansion per aligner and the number of attachments to the maxillary teeth are potential clinical factors that can affect the predictability of expansion.


Arch expansion; Mixed dentition; Invisalign first; Predictability

Cite and Share

Chi Hoon Kim,Sang-Jin Moon,Chung-Min Kang,Je Seon Song. The predictability of arch expansion with the Invisalign First system in children with mixed dentition: a retrospective study. Journal of Clinical Pediatric Dentistry. 2024. 48(1);91-100.


[1] McNamaraa JA. Maxillary transverse deficiency. American Journal of Orthodontics and Dentofacial Orthopedics. 2000; 117: 567–570.

[2] Krishnan V, Daniel ST, Lazar D, Asok A. Characterization of posed smile by using visual analog scale, smile arc, buccal corridor measures, and modified smile index. American Journal of Orthodontics and Dentofacial Orthopedics. 2008; 133: 515–523.

[3] Pinho T, Rocha D, Ribeiro S, Monteiro F, Pascoal S, Azevedo R. Interceptive treatment with Invisalign® First in moderate and severe cases: a case series. Children. 2022; 9: 1176.

[4] Melsen B. Northcroft lecture: how has the spectrum of orthodontics changed over the past decades? Journal of Orthodontics. 2011; 38: 134–143.

[5] Cong A, Ruellas ACDO, Tai SK, Loh CT, Barkley M, Yatabe M, et al. Presurgical orthodontic decompensation with clear aligners. American Journal of Orthodontics and Dentofacial Orthopedics. 2022; 162: 538–553.

[6] Ojima K, Dan C, Kumagai Y, Watanabe H, Nanda R. Correction of severe crowding in teenage patients using the Invisalign system. Journal of Clinical Orthodontics. 2020; 54: 383–391.

[7] Dai F, Xu T, Shu G. Comparison of achieved and predicted crown movement in adults after 4 first premolar extraction treatment with Invisalign. American Journal of Orthodontics and Dentofacial Orthopedics. 2021; 160: 805–813.

[8] Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi CL. Efficacy of clear aligners in controlling orthodontic tooth movement: a systematic review. The Angle Orthodontist. 2015; 85: 881–889.

[9] Azaripour A, Weusmann J, Mahmoodi B, Peppas D, Gerhold-Ay A, Van Noorden CJF, et al. Braces versus Invisalign®: gingival parameters and patients’ satisfaction during treatment: a cross-sectional study. BMC Oral Health. 2015; 15: 69.

[10] Cardoso PC, Espinosa DG, Mecenas P, Flores-Mir C, Normando D. Pain level between clear aligners and fixed appliances: a systematic review. Progress in Orthodontics. 2020; 21: 3.

[11] Lynch NM, Shroff B, Carrico CK, Sawicki V, Sabol M, Lindauer SJ. Clear aligner therapy in the mixed dentition: indications and practitioner perspectives. American Journal of Orthodontics and Dentofacial Orthopedics. 2023; 164: 172–182.

[12] Houle J, Piedade L, Todescan R, Pinheiro FHSL. The predictability of transverse changes with Invisalign. The Angle Orthodontist. 2017; 87: 19–24.

[13] Tien R, Patel V, Chen T, Lavrin I, Naoum S, Lee RJH, et al. The predictability of expansion with Invisalign: a retrospective cohort study. American Journal of Orthodontics and Dentofacial Orthopedics. 2023; 163: 47–53.

[14] Zhou N, Guo J. Efficiency of upper arch expansion with the Invisalign system. The Angle Orthodontist. 2020; 90: 23–30.

[15] Lione R, Paoloni V, Bartolommei L, Gazzani F, Meuli S, Pavoni C, et al. Maxillary arch development with Invisalign system. The Angle Orthodontist. 2021; 91: 433–440.

[16] Lione R, Cretella Lombardo E, Paoloni V, Meuli S, Pavoni C, Cozza P. Upper arch dimensional changes with clear aligners in the early mixed dentition. Journal of Orofacial Orthopedics. 2023; 84: 33–40.

[17] Gonçalves A, Ayache S, Monteiro F, Silva FS, Pinho T. Efficiency of Invisalign First® to promote expansion movement in mixed dentition: a retrospective study and systematic review. European Journal of Paediatric Dentistry. 2023; 24: 112–123.

[18] Abbate GM, Caria MP, Montanari P, Mannu C, Orrù G, Caprioglio A, et al. Periodontal health in teenagers treated with removable aligners and fixed orthodontic appliances. Journal of Orofacial Orthopedics. 2015; 76: 240–250.

[19] Gou Y, Ungvijanpunya N, Chen L, Zeng Y, Ye H, Cao L. Clear aligner vs. fixed self-ligating appliances: orthodontic emergency during the 2020 coronavirus disease 2019 pandemic. American Journal of Orthodontics and Dentofacial Orthopedics. 2022; 161: e400–e406.

[20] Sharma R, Drummond R, Wiltshire W, Schroth R, Lekic M, Bertone M, et al. Quality of life in an adolescent orthodontic population. The Angle Orthodontist. 2021; 91: 718–724.

[21] Nakornchai S, Banditsing P, Visetratana N. Clinical evaluation of 3Mix and Vitapex as treatment options for pulpally involved primary molars. International Journal of Paediatric Dentistry. 2010; 20: 214–221.

[22] Chen X, Liu X, Zhong J. Clinical and radiographic evaluation of pulpectomy in primary teeth: a 18-months clinical randomized controlled trial. Head & Face Medicine. 2017; 13: 12.

[23] Kravitz ND, Kusnoto B, BeGole E, Obrez A, Agran B. How well does Invisalign work? A prospective clinical study evaluating the efficacy of tooth movement with Invisalign. American Journal of Orthodontics and Dentofacial Orthopedics. 2009; 135: 27–35.

[24] Tuncay O, Bowman SJ, Amy B, Nicozisis J. Aligner treatment in the teenage patient. Journal of Clinical Orthodontics. 2013; 47: 115–119; quiz 140.

[25] Jones ML, Mah J, O’Toole BJ. Retention of thermoformed aligners with attachments of various shapes and positions. Journal of Clinical Orthodontics. 2009; 43: 113–117.

[26] Jedliński M, Mazur M, Greco M, Belfus J, Grocholewicz K, Janiszewska-Olszowska J. Attachments for the orthodontic aligner treatment-state of the Art-A comprehensive systematic review. International Journal of Environmental Research and Public Health. 2023; 20: 4481.

[27] Simon M, Keilig L, Schwarze J, Jung BA, Bourauel C. Treatment outcome and efficacy of an aligner technique—regarding incisor torque, premolar derotation and molar distalization. BMC Oral Health. 2014; 14: 68.

[28] Marshall S, Dawson D, Southard KA, Lee AN, Casko JS, Southard TE. Transverse molar movements during growth. American Journal of Orthodontics and Dentofacial Orthopedics. 2003; 124: 615–624.

[29] Li X, Ren C, Wang Z, Zhao P, Wang H, Bai Y. Changes in force associated with the amount of aligner activation and lingual bodily movement of the maxillary central incisor. The Korean Journal of Orthodontics. 2016; 46: 65.

[30] Fan D, Liu H, Yuan CY, Wang SY, Wang PL. Effectiveness of the attachment position in molar intrusion with clear aligners: a finite element study. BMC Oral Health. 2022; 22: 474.

[31] Bishara SE, Ortho D, Jakobsen JR, Treder J, Nowak A. Arch width changes from 6 weeks to 45 years of age. American Journal of Orthodontics and Dentofacial Orthopedics. 1997; 111: 401–409.

[32] Al-Nadawi M, Kravitz ND, Hansa I, Makki L, Ferguson DJ, Vaid NR. Effect of clear aligner wear protocol on the efficacy of tooth movement. The Angle Orthodontist. 2021; 91: 157–163.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

PubMed (MEDLINE) PubMed comprises more than 35 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full text content from PubMed Central and publisher web sites.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Scopus: CiteScore 2.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Submission Turnaround Time