{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T23:33:27Z","timestamp":1791416007101,"version":"4.3.3"},"reference-count":30,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n To compare the efficacy and efficiency of treatment with clear aligners (CAT) vs fixed appliances (FAT) in adolescents with Class I and II moderate to severe malocclusions.<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods<\/jats:title>\n One operator\u2019s (Garfinkle) cases from 2014 to 2019, started at age 12\u201318 years, with pre- and posttreatment records were identified and used according to an institutional review board\u2013approved protocol. Records were measured by two calibrated, blinded investigators, aided by software (OrthoCAD [Cadent, Fairview, N.J.], Dolphin Imaging & Management Solutions [Chatsworth, Calif]). Discrepancy index (DI) and cast radiograph evaluation (CRE) scores, treatment duration, number of scheduled and emergency visits, and reported appliance and interarch elastic wear compliance were compared between groups using Wilcoxon rank sum and Fisher\u2019s exact tests. Cephalometric superimpositions were completed to evaluate craniofacial growth and dental changes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Records from 72 cases met the criteria and were included. For the 47 CAT and 25 FAT cases, mean DI (21 \u00b1 5 and 24 \u00b1 8, respectively;\n P<\/jats:italic>\n = .20) and CRE (35 \u00b1 10 and 34 \u00b1 9, respectively;\n P<\/jats:italic>\n = .90) scores were not significantly different. Other case attributes and reported appliance and interarch elastic wear compliance were also not significantly different. CAT vs FAT cases had significantly smaller treatment durations (24 \u00b1 6 vs 27 \u00b1 5 months;\n P<\/jats:italic>\n = .01) and visit numbers (16 \u00b1 5 vs 24 \u00b1 4;\n P<\/jats:italic>\n < .01), but emergency visit numbers were not significantly different (2 \u00b1 2 vs 3 \u00b1 2;\n P<\/jats:italic>\n = .08).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In adolescents with Class I and II malocclusions and moderate to severe DI scores, on average, CAT vs FAT cases were completed 3 months faster with eight fewer visits, but treatment efficacy was not significantly different.<\/jats:p>\n <\/jats:sec>","DOI":"10.2319\/020923-94.1","type":"journal-article","created":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T22:36:10Z","timestamp":1688596570000},"page":"644-651","source":"Crossref","is-referenced-by-count":17,"title":["Outcome assessment of orthodontic clear aligner vs fixed appliance treatment in adolescents with moderate to severe malocclusions"],"prefix":"10.2319","volume":"93","author":[{"given":"Byron","family":"Chou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey C.","family":"Nickel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongseok","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judah S.","family":"Garfinkle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard M.","family":"Freedman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura R.","family":"Iwasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i1945-7103-93-6-644-b01","series-title":"Am J Orthod Dentofacial Orthop","first-page":"292","article-title":"Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system","volume":"128","author":"Djeu","year":"2005","unstructured":"Djeu\n G,\n \n \n Shelton\n C,\n \n \n Maganzini\n A.\n \n \n Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system. Am J Orthod Dentofacial Orthop. 2005;\n128:292\u2013298; discussion 298."},{"key":"i1945-7103-93-6-644-b02","series-title":"J Dent Educ","first-page":"946","article-title":"Esthetic orthodontic treatment using the Invisalign appliance for moderate to complex malocclusions","volume":"72","author":"Boyd","year":"2008","unstructured":"Boyd\n RL.\n \n \n Esthetic orthodontic treatment using the Invisalign appliance for moderate to complex malocclusions. J Dent Educ. 2008;\n72:946\u2013967."},{"key":"i1945-7103-93-6-644-b03","series-title":"BMC Oral Health","first-page":"24","article-title":"A comparison of treatment effectiveness between clear aligner and fixed appliance therapies","volume":"19","author":"Ke","year":"2019","unstructured":"Ke\n Y,\n \n \n Zhu\n Y,\n \n \n Zhu\n M.\n \n \n A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health. 2019;\n19:24."},{"key":"i1945-7103-93-6-644-b04","series-title":"Prog Orthod","first-page":"37","article-title":"Clinical effectiveness of Invisalign\u00ae orthodontic treatment: a systematic review","volume":"19","author":"Papadimitriou","year":"2018","unstructured":"Papadimitriou\n A,\n \n \n Mousoulea\n S,\n \n \n Gkantidis\n N,\n \n \n Kloukos\n D.\n \n \n Clinical effectiveness of Invisalign\u00ae orthodontic treatment: a systematic review. Prog Orthod. 2018;\n19:37."},{"key":"i1945-7103-93-6-644-b05","series-title":"Orthod Craniofac Res","first-page":"133","article-title":"Effectiveness of clear aligner therapy for orthodontic treatment: a systematic review","volume":"23","author":"Robertson","year":"2020","unstructured":"Robertson\n L,\n \n \n Kaur\n H,\n \n \n Fagundes\n NCF,\n \n \n Romanyk\n D,\n \n \n Major\n P,\n \n \n Flores Mir\n C.\n \n \n Effectiveness of clear aligner therapy for orthodontic treatment: a systematic review. Orthod Craniofac Res. 2020;\n23:133\u2013142."},{"key":"i1945-7103-93-6-644-b06","series-title":"Angle Orthod","first-page":"485","article-title":"Outcome assessment of orthodontic clear aligner vs fixed appliance treatment in a teenage population with mild malocclusions","volume":"90","author":"Borda","year":"2020","unstructured":"Borda\n AF,\n \n \n Garfinkle\n JS,\n \n \n Covell\n DA,\n \n \n Wang\n M,\n \n \n Doyle\n L,\n \n \n Sedgley\n CM.\n \n \n Outcome assessment of orthodontic clear aligner vs fixed appliance treatment in a teenage population with mild malocclusions. Angle Orthod. 2020;\n90:485\u2013490."},{"key":"i1945-7103-93-6-644-b07","series-title":"Am J Orthod Dentofacial Orthop","first-page":"546","article-title":"Reliability and the smallest detectable differences of lateral cephalometric measurements","volume":"138","author":"Damstra","year":"2010","unstructured":"Damstra\n J,\n \n \n Huddleston Slater\n JJ,\n \n \n Fourie\n Z,\n \n \n Ren\n Y.\n \n \n Reliability and the smallest detectable differences of lateral cephalometric measurements. Am J Orthod Dentofacial Orthop. 2010;\n138:546. e541\u2013e548; discussion 546\u2013547."},{"key":"i1945-7103-93-6-644-b08","series-title":"Eur J Orthod","first-page":"655","article-title":"The reproducibility of cephalometric measurements: a comparison of analogue and digital methods","volume":"24","author":"Ongkosuwito","year":"2002","unstructured":"Ongkosuwito\n EM,\n \n \n Katsaros\n C,\n \n \n van \u2019t Hof\n MA,\n \n \n Bodegom\n JC,\n \n \n Kuijpers-Jagtman\n AM.\n \n \n The reproducibility of cephalometric measurements: a comparison of analogue and digital methods. Eur J Orthod. 2002;\n24:655\u2013665."},{"key":"i1945-7103-93-6-644-b09","author":"American Board of Orthodontics","unstructured":"American Board of Orthodontics\n . Downloads and Resources; available at: https:\/\/www.americanboardortho.com\/orthodontists\/board-certified-orthodontist-support\/downloads-and-resources\/. Accessed August 13, 2022."},{"key":"i1945-7103-93-6-644-b10","series-title":"J Chiropr Med","first-page":"155","article-title":"A guideline of selecting and reporting intraclass correlation coefficients for reliability research","volume":"15","author":"Koo","year":"2016","unstructured":"Koo\n TK,\n \n \n Li\n MY.\n \n \n A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;\n15:155\u2013163."},{"key":"i1945-7103-93-6-644-b11","series-title":"J World Fed Orthod","first-page":"e61","article-title":"Assessment of Invisalign treatment outcomes using the ABO Model Grading System","volume":"2","author":"Kassas","year":"2013","unstructured":"Kassas\n W,\n \n \n Al-Jewair\n T,\n \n \n Preston\n CB,\n \n \n Tabbaa\n S.\n \n \n Assessment of Invisalign treatment outcomes using the ABO Model Grading System. J World Fed Orthod. 2013;\n2:e61\u2013e64."},{"key":"i1945-7103-93-6-644-b12","series-title":"Turk J Orthod","first-page":"241","article-title":"Orthodontic treatment with clear aligners and the scientific reality behind their marketing: a literature review","volume":"32","author":"Tamer","year":"2019","unstructured":"Tamer\n I,\n \n \n Oztas\n E,\n \n \n Marsan\n G.\n \n \n Orthodontic treatment with clear aligners and the scientific reality behind their marketing: a literature review. Turk J Orthod. 2019;\n32:241\u2013246."},{"key":"i1945-7103-93-6-644-b13","series-title":"Am J Orthod Dentofacial Orthop","first-page":"886","article-title":"Comparison of automated grading of digital orthodontic models and hand grading of 3-dimensionally printed models","volume":"155","author":"Scott","year":"2019","unstructured":"Scott\n JD,\n \n \n English\n JD,\n \n \n Cozad\n BE,\n \n et al.\n \n Comparison of automated grading of digital orthodontic models and hand grading of 3-dimensionally printed models. Am J Orthod Dentofacial Orthop. 2019;\n155:886\u2013890."},{"key":"i1945-7103-93-6-644-b14","series-title":"Am J Orthod Dentofacial Orthop","first-page":"259","article-title":"Evaluation of Invisalign treatment effectiveness and efficiency compared with conventional fixed appliances using the Peer Assessment Rating index","volume":"151","author":"Gu","year":"2017","unstructured":"Gu\n J,\n \n \n Tang\n JS,\n \n \n Skulski\n B,\n \n et al.\n \n Evaluation of Invisalign treatment effectiveness and efficiency compared with conventional fixed appliances using the Peer Assessment Rating index. Am J Orthod Dentofacial Orthop. 2017;\n151:259\u2013266."},{"key":"i1945-7103-93-6-644-b15","series-title":"Orthod Craniofac Res","first-page":"127","article-title":"Efficiency, effectiveness and treatment stability of clear aligners: a systematic review and meta-analysis","volume":"20","author":"Zheng","year":"2017","unstructured":"Zheng\n M,\n \n \n Liu\n R,\n \n \n Ni\n Z,\n \n \n Yu\n Z.\n \n \n Efficiency, effectiveness and treatment stability of clear aligners: a systematic review and meta-analysis. Orthod Craniofac Res. 2017;\n20:127\u2013133."},{"key":"i1945-7103-93-6-644-b01","series-title":"Am J Orthod Dentofacial Orthop","first-page":"292","article-title":"Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system","volume":"128","author":"Djeu","year":"2005","unstructured":"Djeu\n G,\n \n \n Shelton\n C,\n \n \n Maganzini\n A.\n \n \n Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system. Am J Orthod Dentofacial Orthop. 2005;\n128:292\u2013298; discussion 298."},{"key":"i1945-7103-93-6-644-b02","series-title":"J Dent Educ","first-page":"946","article-title":"Esthetic orthodontic treatment using the Invisalign appliance for moderate to complex malocclusions","volume":"72","author":"Boyd","year":"2008","unstructured":"Boyd\n RL.\n \n \n Esthetic orthodontic treatment using the Invisalign appliance for moderate to complex malocclusions. J Dent Educ. 2008;\n72:946\u2013967."},{"key":"i1945-7103-93-6-644-b03","series-title":"BMC Oral Health","first-page":"24","article-title":"A comparison of treatment effectiveness between clear aligner and fixed appliance therapies","volume":"19","author":"Ke","year":"2019","unstructured":"Ke\n Y,\n \n \n Zhu\n Y,\n \n \n Zhu\n M.\n \n \n A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health. 2019;\n19:24."},{"key":"i1945-7103-93-6-644-b04","series-title":"Prog Orthod","first-page":"37","article-title":"Clinical effectiveness of Invisalign\u00ae orthodontic treatment: a systematic review","volume":"19","author":"Papadimitriou","year":"2018","unstructured":"Papadimitriou\n A,\n \n \n Mousoulea\n S,\n \n \n Gkantidis\n N,\n \n \n Kloukos\n D.\n \n \n Clinical effectiveness of Invisalign\u00ae orthodontic treatment: a systematic review. Prog Orthod. 2018;\n19:37."},{"key":"i1945-7103-93-6-644-b05","series-title":"Orthod Craniofac Res","first-page":"133","article-title":"Effectiveness of clear aligner therapy for orthodontic treatment: a systematic review","volume":"23","author":"Robertson","year":"2020","unstructured":"Robertson\n L,\n \n \n Kaur\n H,\n \n \n Fagundes\n NCF,\n \n \n Romanyk\n D,\n \n \n Major\n P,\n \n \n Flores Mir\n C.\n \n \n Effectiveness of clear aligner therapy for orthodontic treatment: a systematic review. Orthod Craniofac Res. 2020;\n23:133\u2013142."},{"key":"i1945-7103-93-6-644-b06","series-title":"Angle Orthod","first-page":"485","article-title":"Outcome assessment of orthodontic clear aligner vs fixed appliance treatment in a teenage population with mild malocclusions","volume":"90","author":"Borda","year":"2020","unstructured":"Borda\n AF,\n \n \n Garfinkle\n JS,\n \n \n Covell\n DA,\n \n \n Wang\n M,\n \n \n Doyle\n L,\n \n \n Sedgley\n CM.\n \n \n Outcome assessment of orthodontic clear aligner vs fixed appliance treatment in a teenage population with mild malocclusions. Angle Orthod. 2020;\n90:485\u2013490."},{"key":"i1945-7103-93-6-644-b07","series-title":"Am J Orthod Dentofacial Orthop","first-page":"546","article-title":"Reliability and the smallest detectable differences of lateral cephalometric measurements","volume":"138","author":"Damstra","year":"2010","unstructured":"Damstra\n J,\n \n \n Huddleston Slater\n JJ,\n \n \n Fourie\n Z,\n \n \n Ren\n Y.\n \n \n Reliability and the smallest detectable differences of lateral cephalometric measurements. Am J Orthod Dentofacial Orthop. 2010;\n138:546. e541\u2013e548; discussion 546\u2013547."},{"key":"i1945-7103-93-6-644-b08","series-title":"Eur J Orthod","first-page":"655","article-title":"The reproducibility of cephalometric measurements: a comparison of analogue and digital methods","volume":"24","author":"Ongkosuwito","year":"2002","unstructured":"Ongkosuwito\n EM,\n \n \n Katsaros\n C,\n \n \n van \u2019t Hof\n MA,\n \n \n Bodegom\n JC,\n \n \n Kuijpers-Jagtman\n AM.\n \n \n The reproducibility of cephalometric measurements: a comparison of analogue and digital methods. Eur J Orthod. 2002;\n24:655\u2013665."},{"key":"i1945-7103-93-6-644-b09","author":"American Board of Orthodontics","unstructured":"American Board of Orthodontics\n . Downloads and Resources; available at: https:\/\/www.americanboardortho.com\/orthodontists\/board-certified-orthodontist-support\/downloads-and-resources\/. Accessed August 13, 2022."},{"key":"i1945-7103-93-6-644-b10","series-title":"J Chiropr Med","first-page":"155","article-title":"A guideline of selecting and reporting intraclass correlation coefficients for reliability research","volume":"15","author":"Koo","year":"2016","unstructured":"Koo\n TK,\n \n \n Li\n MY.\n \n \n A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;\n15:155\u2013163."},{"key":"i1945-7103-93-6-644-b11","series-title":"J World Fed Orthod","first-page":"e61","article-title":"Assessment of Invisalign treatment outcomes using the ABO Model Grading System","volume":"2","author":"Kassas","year":"2013","unstructured":"Kassas\n W,\n \n \n Al-Jewair\n T,\n \n \n Preston\n CB,\n \n \n Tabbaa\n S.\n \n \n Assessment of Invisalign treatment outcomes using the ABO Model Grading System. J World Fed Orthod. 2013;\n2:e61\u2013e64."},{"key":"i1945-7103-93-6-644-b12","series-title":"Turk J Orthod","first-page":"241","article-title":"Orthodontic treatment with clear aligners and the scientific reality behind their marketing: a literature review","volume":"32","author":"Tamer","year":"2019","unstructured":"Tamer\n I,\n \n \n Oztas\n E,\n \n \n Marsan\n G.\n \n \n Orthodontic treatment with clear aligners and the scientific reality behind their marketing: a literature review. Turk J Orthod. 2019;\n32:241\u2013246."},{"key":"i1945-7103-93-6-644-b13","series-title":"Am J Orthod Dentofacial Orthop","first-page":"886","article-title":"Comparison of automated grading of digital orthodontic models and hand grading of 3-dimensionally printed models","volume":"155","author":"Scott","year":"2019","unstructured":"Scott\n JD,\n \n \n English\n JD,\n \n \n Cozad\n BE,\n \n et al.\n \n Comparison of automated grading of digital orthodontic models and hand grading of 3-dimensionally printed models. Am J Orthod Dentofacial Orthop. 2019;\n155:886\u2013890."},{"key":"i1945-7103-93-6-644-b14","series-title":"Am J Orthod Dentofacial Orthop","first-page":"259","article-title":"Evaluation of Invisalign treatment effectiveness and efficiency compared with conventional fixed appliances using the Peer Assessment Rating index","volume":"151","author":"Gu","year":"2017","unstructured":"Gu\n J,\n \n \n Tang\n JS,\n \n \n Skulski\n B,\n \n et al.\n \n Evaluation of Invisalign treatment effectiveness and efficiency compared with conventional fixed appliances using the Peer Assessment Rating index. Am J Orthod Dentofacial Orthop. 2017;\n151:259\u2013266."},{"key":"i1945-7103-93-6-644-b15","series-title":"Orthod Craniofac Res","first-page":"127","article-title":"Efficiency, effectiveness and treatment stability of clear aligners: a systematic review and meta-analysis","volume":"20","author":"Zheng","year":"2017","unstructured":"Zheng\n M,\n \n \n Liu\n R,\n \n \n Ni\n Z,\n \n \n Yu\n Z.\n \n \n Efficiency, effectiveness and treatment stability of clear aligners: a systematic review and meta-analysis. Orthod Craniofac Res. 2017;\n20:127\u2013133."}],"container-title":["The Angle Orthodontist"],"original-title":[],"link":[{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/view\/journals\/angl\/93\/6\/article-p644.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/meridian.allenpress.com\/angle-orthodontist\/article-pdf\/93\/6\/644\/3284484\/i1945-7103-93-6-644.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/downloadpdf\/journals\/angl\/93\/6\/article-p644.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/downloadpdf\/journals\/angl\/93\/6\/article-p644.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T14:23:49Z","timestamp":1780064629000},"score":1,"resource":{"primary":{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/view\/journals\/angl\/93\/6\/article-p644.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11]]},"references-count":30,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.2319\/020923-94.1","relation":{},"ISSN":["1945-7103","0003-3219"],"issn-type":[{"value":"1945-7103","type":"electronic"},{"value":"0003-3219","type":"print"}],"subject":[],"published":{"date-parts":[[2023,11]]}}}