Preface

The introduction of clear aligners in orthodontics as a treatment modality for complex and difficult cases has gained a worldwide acceptance/attention nowadays due to the increased advantages over regular fixed orthodontic systems. These advantages include, but not limited to the following; 1) Clear aligners are more esthetically acceptable than fixed orthodontic braces including clear (Ceramic or plastic systems) due to the fact that even with regular clear braces, metal wires are still being used which usually are seen from a distance and Teflon coated wires usually undergo peeling off the Teflon coat, which leads to the wire metal be seen; 2) clear aligners require less maintenance compared to regular fixed appliances, in other words, less emergency visits like broken brackets, poking wires and other associated complications with regular fixed orthodontic braces; 3) no food restriction like with clear aligners usually as with regular fixed orthodontic braces since the patients remove the aligners during meals and eat normally, brush and floss normally then wear the aligners back; 4) no human error in bracket positioning like those in regular fixed orthodontic braces. Even with sophisticated computerized indirect bonding techniques that utilize sophisticated computer softwares for bracket positioning with fixed orthodontic braces, most of the time the clinician has to do wire bending and normally finishing fixed orthodontic cases takes at least six to eight months on average, mainly to fix minor human errors in bracket positioning; 5) clear aligners can be more hygienic if the patient brushes his/her teeth normally as there is no much time needed to brush and floss around brackets and wires with regular orthodontic braces, and 6) nowadays difficult and complex tooth movements can be readily obtained by clear aligners when clinicians can utilize basic understanding of orthodontic mechanics during deigning and treatment planning cases using clear aligners. Finally, even in cases with bad oral hygiene when patients may undergo severe enamel decalcification with clear aligners, the aligners can be used as fluoride applicators to help with enamel re-mineralization. This does not mean that orthodontic treatment with clear aligners does not have challenges. Main challenges in orthodontic treatment with clear aligners include but not limited to the following: 1) Treatment efficacy, which could be mainly due to patients compliance, and this is not different in adults or teenagers; 2) challenges related to aligners’ plastic materials which are continuously improving, however there is a lot to be done in research and development (R&D) for optimum results; 3) essential diagnosis and treatment planning of the cases which should not violate basic foundation of orthodontic skeletal/dental and esthetic evaluation and needs for each patient; 4) oral hygiene can be a problem if the patient does not maintain oral hygiene, clear aligners could act as a plaque incubator. This book is intended to present the authors’ own experience with difficult cases including skeletal class I, Class II and Class III as well as facial asymmetry. However, before jumping into deep water, it may be wise to know how to swim in shallow water. This is what this book is intended to provide the reader with step by step diagnosis and treatment planning in general then introduction to biomechanics in orthodontics in general, and finally cases will be presented and discussed in terms of diagnosis, treatment planning and case management. It is also to be noted that this first edition of the book is intended to present initial cases and it is expected in the next editions that more challenging cases will be presented and their treatment planning and results will be discussed. With this, I would like to thank the contributors, all my supporting staff and family for providing support in documenting these cases and also I would like to dedicate this work to my family who sacrificed long hours and days of family time so I can finish this book.