{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T19:32:32Z","timestamp":1790451152275,"version":"4.1.0"},"reference-count":36,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objectives<\/jats:title>\n To investigate the skeletal and dentoalveolar effects of Invisalign's G5 protocol with virtual bite ramps in the treatment of adults with skeletal deep bites.<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods<\/jats:title>\n \n This retrospective study was conducted on consecutively treated adults presenting with skeletal deep bites as defined by the Overbite Depth Indicator (ODI). Subjects were divided into 2 groups: Invisalign group (n = 24) treated with the Invisalign G5 protocol and a full fixed appliance (FFA) group (n = 24) treated with edgewise FFAs and matched to the Invisalign group by ODI, sex, type of malocclusion, and non-extraction treatment. Pretreatment (T\n 1<\/jats:sub>\n ) and post\u2013comprehensive treatment (T\n 2<\/jats:sub>\n ) lateral cephalograms were obtained and analyzed.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Both the Invisalign and FFA groups showed significant changes from T\n 1<\/jats:sub>\n to T\n 2<\/jats:sub>\n in ODI and other skeletal and dentoalveolar measurements. The mean change in ODI was \u22121.5\u00b0 (\n P<\/jats:italic>\n < .001) for the Invisalign group and \u22122.0\u00b0 (\n P<\/jats:italic>\n < .001) for the FFA group. The mean decrease in overbite was 1.3 mm (\n P<\/jats:italic>\n < .001) and 2.0 mm (\n P<\/jats:italic>\n < .001) for the Invisalign and FFA groups, respectively. The mean increase in mandibular plane angle (Sn-GoGn) was 0.65\u00b0 (\n P<\/jats:italic>\n = .003) for the Invisalign group and 1.15\u00b0 (\n P<\/jats:italic>\n < .001) for the FFA group. When the groups were compared with each other, both ODI (\n P<\/jats:italic>\n = .03) and overbite (\n P<\/jats:italic>\n = .003) were significantly different in addition to other measurements.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Although FFA treatment had more apparent skeletal changes for deep bite adult patients when compared with Invisalign, both systems were effective in opening deep bites at dentoalveolar and skeletal levels.<\/jats:p>\n <\/jats:sec>","DOI":"10.2319\/072220-646.1","type":"journal-article","created":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T02:05:53Z","timestamp":1610589953000},"page":"164-170","source":"Crossref","is-referenced-by-count":44,"title":["Effects of Invisalign (G5) with virtual bite ramps for skeletal deep overbite malocclusion correction in adults"],"prefix":"10.2319","volume":"91","author":[{"given":"Douglas","family":"Henick","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willy","family":"Dayan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Dunford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Warunek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thikriat","family":"Al-Jewair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"issue":"(4)","key":"i0003-3219-91-2-164-b01","series-title":"Am J Orthod Dentofacial Orthop","first-page":"382","article-title":"Skeletal and dental changes associated with the treatment of deep bite malocclusion","volume":"107","author":"Parker","year":"1995","unstructured":"Parker\n CD,\n \n \n Nanda\n RS,\n \n \n Currier\n GF.\n \n \n Skeletal and dental changes associated with the treatment of deep bite malocclusion.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop1995;\n\t\t\t\t\t107(4):\n\t\t\t\t\t382\u2013\n\t\t\t\t\t393."},{"issue":"(1)","key":"i0003-3219-91-2-164-b02","series-title":"Dent Clin North Am","first-page":"67","article-title":"Correction of deep overbite in adults","volume":"41","author":"Nanda","year":"1997","unstructured":"Nanda\n R.\n \n \n Correction of deep overbite in adults.\n\t\t\t\t\tDent Clin North Am1997;\n\t\t\t\t\t41(1):\n\t\t\t\t\t67\u2013\n\t\t\t\t\t87."},{"issue":"(3)","key":"i0003-3219-91-2-164-b03","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.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop2005;\n\t\t\t\t\t128(3):\n\t\t\t\t\t292\u2013\n\t\t\t\t\t298;\n\t\t\t\t\tdiscussion 98."},{"issue":"(1)","key":"i0003-3219-91-2-164-b04","series-title":"Aust Orthod J","first-page":"34","article-title":"Short-term chemical and physical changes in invisalign appliances","volume":"25","author":"Gracco","year":"2009","unstructured":"Gracco\n A,\n \n \n Mazzoli\n A,\n \n \n Favoni\n O,\n \n et al.\n \n Short-term chemical and physical changes in invisalign appliances.\n\t\t\t\t\tAust Orthod J2009;\n\t\t\t\t\t25(1):\n\t\t\t\t\t34\u2013\n\t\t\t\t\t40."},{"issue":"(4)","key":"i0003-3219-91-2-164-b05","series-title":"J Clin Orthod","first-page":"245","article-title":"Surgical-orthodontic treatment of two skeletal Class III patients with Invisalign and fixed appliances","volume":"39","author":"Boyd","year":"2005","unstructured":"Boyd\n RL.\n \n \n Surgical-orthodontic treatment of two skeletal Class III patients with Invisalign and fixed appliances.\n\t\t\t\t\tJ Clin Orthod2005;\n\t\t\t\t\t39(4):\n\t\t\t\t\t245\u2013\n\t\t\t\t\t258."},{"key":"i0003-3219-91-2-164-b06","series-title":"Improved Clinical Outcomes for Deep Bite Treatment","article-title":"Invisalign G5 Innovations","year":"2016","unstructured":"Invisalign.\n Invisalign G5 Innovations.\n\t\t\t\t\tImproved Clinical Outcomes for Deep Bite Treatment;\n\t\t\t\t\t2016.\n\t\t\t\t\tAlign Technology, Inc. www.invisalign.com\/braces-for-adults-and-teens; Accessed 8\/1\/2017"},{"key":"i0003-3219-91-2-164-b07","series-title":"Invisalign G5 Innovations for Deep Bite","year":"2013","unstructured":"Invisalign.\n \n Invisalign G5 Innovations for Deep Bite\n .\n\t\t\t\t\tSan Jose, CA:\n\t\t\t\t\tAlign Technology, Inc.;2013."},{"issue":"(4)","key":"i0003-3219-91-2-164-b08","series-title":"Am J Orthod Dentofacial Orthop","first-page":"691","article-title":"Management of overbite with the Invisalign appliance","volume":"151","author":"Khosravi","year":"2017","unstructured":"Khosravi\n R,\n \n \n Cohanim\n B,\n \n \n Hujoel\n P,\n \n et al.\n \n Management of overbite with the Invisalign appliance.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop2017;\n\t\t\t\t\t151(4):\n\t\t\t\t\t691\u2013\n\t\t\t\t\t99e2."},{"issue":"(1)","key":"i0003-3219-91-2-164-b09","series-title":"Am J Orthod Dentofacial Orthop","first-page":"75","article-title":"Early vs late orthodontic treatment of deepbite: a prospective clinical trial in growing subjects","volume":"142","author":"Baccetti","year":"2012","unstructured":"Baccetti\n T,\n \n \n Franchi\n L,\n \n \n Giuntini\n V,\n \n et al.\n \n Early vs late orthodontic treatment of deepbite: a prospective clinical trial in growing subjects.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop2012;\n\t\t\t\t\t142(1):\n\t\t\t\t\t75\u2013\n\t\t\t\t\t82."},{"issue":"(6)","key":"i0003-3219-91-2-164-b10","series-title":"Am J Orthod","first-page":"586","article-title":"Overbite depth indicator with particular reference to anterior open-bite","volume":"65","author":"Kim","year":"1974","unstructured":"Kim\n YH.\n \n \n Overbite depth indicator with particular reference to anterior open-bite.\n\t\t\t\t\tAm J Orthod1974;\n\t\t\t\t\t65(6):\n\t\t\t\t\t586\u2013\n\t\t\t\t\t611."},{"issue":"(1)","key":"i0003-3219-91-2-164-b11","series-title":"Am J Orthod Dentofacial Orthop","first-page":"72","article-title":"A comparison of the Ricketts and Tweed-type arch leveling techniques","volume":"95","author":"Dake","year":"1989","unstructured":"Dake\n ML,\n \n \n Sinclair\n PM.\n \n \n A comparison of the Ricketts and Tweed-type arch leveling techniques.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop1989;\n\t\t\t\t\t95(1):\n\t\t\t\t\t72\u2013\n\t\t\t\t\t78."},{"issue":"(4)","key":"i0003-3219-91-2-164-b12","series-title":"Am J Orthod Dentofacial Orthop","first-page":"370","article-title":"The skeletodental adaptations in deep bite correction","volume":"100","author":"McDowell","year":"1991","unstructured":"McDowell\n EH,\n \n \n Baker\n IM.\n \n \n The skeletodental adaptations in deep bite correction.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop1991;\n\t\t\t\t\t100(4):\n\t\t\t\t\t370\u2013\n\t\t\t\t\t375."},{"issue":"(3)","key":"i0003-3219-91-2-164-b13","series-title":"Am J Orthod Dentofacial Orthop","first-page":"414","article-title":"Deepbite correction with incisor intrusion in adults: a long-term cephalometric study","volume":"144","year":"2013","unstructured":"Kale Varlik\n S,\n \n \n Onur Alpakan\n O,\n \n \n Turkoz\n C.\n \n Deepbite correction with incisor intrusion in adults: a long-term cephalometric study.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop2013;\n\t\t\t\t\t144(3):\n\t\t\t\t\t414\u2013\n\t\t\t\t\t9."},{"issue":"(1)","key":"i0003-3219-91-2-164-b14","series-title":"J Clin Orthod","first-page":"28","article-title":"Class II correction with the Invisalign system","volume":"44","author":"Schupp","year":"2010","unstructured":"Schupp\n W,\n \n \n Haubrich\n J,\n \n \n Neumann\n I.\n \n \n Class II correction with the Invisalign system.\n\t\t\t\t\tJ Clin Orthod2010;\n\t\t\t\t\t44(1):\n\t\t\t\t\t28\u2013\n\t\t\t\t\t35."},{"issue":"(8)","key":"i0003-3219-91-2-164-b15","series-title":"J Dent Educ","first-page":"948","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.\n\t\t\t\t\tJ Dent Educ2008;\n\t\t\t\t\t72(8):\n\t\t\t\t\t948\u2013\n\t\t\t\t\t967."},{"issue":"(1)","key":"i0003-3219-91-2-164-b16","series-title":"Eur J Orthod","first-page":"75","article-title":"Stability of deep overbite correction","volume":"5","author":"Berg","year":"1983","unstructured":"Berg\n R.\n \n \n Stability of deep overbite correction.\n\t\t\t\t\tEur J Orthod1983;\n\t\t\t\t\t5(1):\n\t\t\t\t\t75\u2013\n\t\t\t\t\t83."},{"issue":"(1)","key":"i0003-3219-91-2-164-b17","series-title":"Am J Orthod","first-page":"1","article-title":"Treatment of deep-bite cases","volume":"77","author":"Engel","year":"1980","unstructured":"Engel\n G,\n \n \n Cornforth\n G,\n \n \n Damerell\n JM,\n \n et al.\n \n Treatment of deep-bite cases.\n\t\t\t\t\tAm J Orthod1980;\n\t\t\t\t\t77(1):\n\t\t\t\t\t1\u2013\n\t\t\t\t\t13."},{"issue":"(3)","key":"i0003-3219-91-2-164-b18","series-title":"J World Fed Orthod","first-page":"e89","article-title":"Stability of deep-bite correction: a systematic review","volume":"1","author":"Huang","year":"2012","unstructured":"Huang\n GJ,\n \n \n Bates\n SB,\n \n \n Ehlert\n AA,\n \n et al.\n \n Stability of deep-bite correction: a systematic review.\n\t\t\t\t\tJ World Fed Orthod2012;\n\t\t\t\t\t1(3):\n\t\t\t\t\te89\u2013\n\t\t\t\t\te86."},{"issue":"(4)","key":"i0003-3219-91-2-164-b01","series-title":"Am J Orthod Dentofacial Orthop","first-page":"382","article-title":"Skeletal and dental changes associated with the treatment of deep bite malocclusion","volume":"107","author":"Parker","year":"1995","unstructured":"Parker\n CD,\n \n \n Nanda\n RS,\n \n \n Currier\n GF.\n \n \n Skeletal and dental changes associated with the treatment of deep bite malocclusion.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop1995;\n\t\t\t\t\t107(4):\n\t\t\t\t\t382\u2013\n\t\t\t\t\t393."},{"issue":"(1)","key":"i0003-3219-91-2-164-b02","series-title":"Dent Clin North Am","first-page":"67","article-title":"Correction of deep overbite in adults","volume":"41","author":"Nanda","year":"1997","unstructured":"Nanda\n R.\n \n \n Correction of deep overbite in adults.\n\t\t\t\t\tDent Clin North Am1997;\n\t\t\t\t\t41(1):\n\t\t\t\t\t67\u2013\n\t\t\t\t\t87."},{"issue":"(3)","key":"i0003-3219-91-2-164-b03","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.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop2005;\n\t\t\t\t\t128(3):\n\t\t\t\t\t292\u2013\n\t\t\t\t\t298;\n\t\t\t\t\tdiscussion 98."},{"issue":"(1)","key":"i0003-3219-91-2-164-b04","series-title":"Aust Orthod J","first-page":"34","article-title":"Short-term chemical and physical changes in invisalign appliances","volume":"25","author":"Gracco","year":"2009","unstructured":"Gracco\n A,\n \n \n Mazzoli\n A,\n \n \n Favoni\n O,\n \n et al.\n \n Short-term chemical and physical changes in invisalign appliances.\n\t\t\t\t\tAust Orthod J2009;\n\t\t\t\t\t25(1):\n\t\t\t\t\t34\u2013\n\t\t\t\t\t40."},{"issue":"(4)","key":"i0003-3219-91-2-164-b05","series-title":"J Clin Orthod","first-page":"245","article-title":"Surgical-orthodontic treatment of two skeletal Class III patients with Invisalign and fixed appliances","volume":"39","author":"Boyd","year":"2005","unstructured":"Boyd\n RL.\n \n \n Surgical-orthodontic treatment of two skeletal Class III patients with Invisalign and fixed appliances.\n\t\t\t\t\tJ Clin Orthod2005;\n\t\t\t\t\t39(4):\n\t\t\t\t\t245\u2013\n\t\t\t\t\t258."},{"key":"i0003-3219-91-2-164-b06","series-title":"Improved Clinical Outcomes for Deep Bite Treatment","article-title":"Invisalign G5 Innovations","year":"2016","unstructured":"Invisalign.\n Invisalign G5 Innovations.\n\t\t\t\t\tImproved Clinical Outcomes for Deep Bite Treatment;\n\t\t\t\t\t2016.\n\t\t\t\t\tAlign Technology, Inc. www.invisalign.com\/braces-for-adults-and-teens; Accessed 8\/1\/2017"},{"key":"i0003-3219-91-2-164-b07","series-title":"Invisalign G5 Innovations for Deep Bite","year":"2013","unstructured":"Invisalign.\n \n Invisalign G5 Innovations for Deep Bite\n .\n\t\t\t\t\tSan Jose, CA:\n\t\t\t\t\tAlign Technology, Inc.;2013."},{"issue":"(4)","key":"i0003-3219-91-2-164-b08","series-title":"Am J Orthod Dentofacial Orthop","first-page":"691","article-title":"Management of overbite with the Invisalign appliance","volume":"151","author":"Khosravi","year":"2017","unstructured":"Khosravi\n R,\n \n \n Cohanim\n B,\n \n \n Hujoel\n P,\n \n et al.\n \n Management of overbite with the Invisalign appliance.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop2017;\n\t\t\t\t\t151(4):\n\t\t\t\t\t691\u2013\n\t\t\t\t\t99e2."},{"issue":"(1)","key":"i0003-3219-91-2-164-b09","series-title":"Am J Orthod Dentofacial Orthop","first-page":"75","article-title":"Early vs late orthodontic treatment of deepbite: a prospective clinical trial in growing subjects","volume":"142","author":"Baccetti","year":"2012","unstructured":"Baccetti\n T,\n \n \n Franchi\n L,\n \n \n Giuntini\n V,\n \n et al.\n \n Early vs late orthodontic treatment of deepbite: a prospective clinical trial in growing subjects.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop2012;\n\t\t\t\t\t142(1):\n\t\t\t\t\t75\u2013\n\t\t\t\t\t82."},{"issue":"(6)","key":"i0003-3219-91-2-164-b10","series-title":"Am J Orthod","first-page":"586","article-title":"Overbite depth indicator with particular reference to anterior open-bite","volume":"65","author":"Kim","year":"1974","unstructured":"Kim\n YH.\n \n \n Overbite depth indicator with particular reference to anterior open-bite.\n\t\t\t\t\tAm J Orthod1974;\n\t\t\t\t\t65(6):\n\t\t\t\t\t586\u2013\n\t\t\t\t\t611."},{"issue":"(1)","key":"i0003-3219-91-2-164-b11","series-title":"Am J Orthod Dentofacial Orthop","first-page":"72","article-title":"A comparison of the Ricketts and Tweed-type arch leveling techniques","volume":"95","author":"Dake","year":"1989","unstructured":"Dake\n ML,\n \n \n Sinclair\n PM.\n \n \n A comparison of the Ricketts and Tweed-type arch leveling techniques.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop1989;\n\t\t\t\t\t95(1):\n\t\t\t\t\t72\u2013\n\t\t\t\t\t78."},{"issue":"(4)","key":"i0003-3219-91-2-164-b12","series-title":"Am J Orthod Dentofacial Orthop","first-page":"370","article-title":"The skeletodental adaptations in deep bite correction","volume":"100","author":"McDowell","year":"1991","unstructured":"McDowell\n EH,\n \n \n Baker\n IM.\n \n \n The skeletodental adaptations in deep bite correction.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop1991;\n\t\t\t\t\t100(4):\n\t\t\t\t\t370\u2013\n\t\t\t\t\t375."},{"issue":"(3)","key":"i0003-3219-91-2-164-b13","series-title":"Am J Orthod Dentofacial Orthop","first-page":"414","article-title":"Deepbite correction with incisor intrusion in adults: a long-term cephalometric study","volume":"144","year":"2013","unstructured":"Kale Varlik\n S,\n \n \n Onur Alpakan\n O,\n \n \n Turkoz\n C.\n \n Deepbite correction with incisor intrusion in adults: a long-term cephalometric study.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop2013;\n\t\t\t\t\t144(3):\n\t\t\t\t\t414\u2013\n\t\t\t\t\t9."},{"issue":"(1)","key":"i0003-3219-91-2-164-b14","series-title":"J Clin Orthod","first-page":"28","article-title":"Class II correction with the Invisalign system","volume":"44","author":"Schupp","year":"2010","unstructured":"Schupp\n W,\n \n \n Haubrich\n J,\n \n \n Neumann\n I.\n \n \n Class II correction with the Invisalign system.\n\t\t\t\t\tJ Clin Orthod2010;\n\t\t\t\t\t44(1):\n\t\t\t\t\t28\u2013\n\t\t\t\t\t35."},{"issue":"(8)","key":"i0003-3219-91-2-164-b15","series-title":"J Dent Educ","first-page":"948","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.\n\t\t\t\t\tJ Dent Educ2008;\n\t\t\t\t\t72(8):\n\t\t\t\t\t948\u2013\n\t\t\t\t\t967."},{"issue":"(1)","key":"i0003-3219-91-2-164-b16","series-title":"Eur J Orthod","first-page":"75","article-title":"Stability of deep overbite correction","volume":"5","author":"Berg","year":"1983","unstructured":"Berg\n R.\n \n \n Stability of deep overbite correction.\n\t\t\t\t\tEur J Orthod1983;\n\t\t\t\t\t5(1):\n\t\t\t\t\t75\u2013\n\t\t\t\t\t83."},{"issue":"(1)","key":"i0003-3219-91-2-164-b17","series-title":"Am J Orthod","first-page":"1","article-title":"Treatment of deep-bite cases","volume":"77","author":"Engel","year":"1980","unstructured":"Engel\n G,\n \n \n Cornforth\n G,\n \n \n Damerell\n JM,\n \n et al.\n \n Treatment of deep-bite cases.\n\t\t\t\t\tAm J Orthod1980;\n\t\t\t\t\t77(1):\n\t\t\t\t\t1\u2013\n\t\t\t\t\t13."},{"issue":"(3)","key":"i0003-3219-91-2-164-b18","series-title":"J World Fed Orthod","first-page":"e89","article-title":"Stability of deep-bite correction: a systematic review","volume":"1","author":"Huang","year":"2012","unstructured":"Huang\n GJ,\n \n \n Bates\n SB,\n \n \n Ehlert\n AA,\n \n et al.\n \n Stability of deep-bite correction: a systematic review.\n\t\t\t\t\tJ World Fed Orthod2012;\n\t\t\t\t\t1(3):\n\t\t\t\t\te89\u2013\n\t\t\t\t\te86."}],"container-title":["The Angle 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