{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T15:06:27Z","timestamp":1780067187783,"version":"3.54.0"},"reference-count":58,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the accuracy of Invisalign ClinCheck in predicting open gingival embrasures (OGEs) and to identify predictors of OGEs in adult extraction cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Fifty-seven adult patients treated with Invisalign and four first premolar extractions were included in this retrospective study. OGEs were measured in maxillary and mandibular anterior regions using posttreatment intraoral photographs (actual OGEs) and the final step from the first treatment plan in ClinCheck (predicted OGEs). Prediction performance indicators including precision, sensitivity, specificity, false positive rate, false negative rate, and accuracy were evaluated at each tooth site. Predictors of OGEs (age, crowding, crown morphology, tooth movement, tooth site, treatment duration, and attachment design) were analyzed using binary logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Incidence of actual OGEs was like that of the ClinCheck predicted OGEs in the maxillary and mandibular anterior regions. The predictability of ClinCheck was satisfactory in both the maxilla and mandible, with accuracy rates of 94.0% and 86.0%, respectively. The most accurate prediction was for the maxillary central incisors, achieving a precision of 100% and an accuracy of 96.6%. The most significant predictors of OGEs included patient age at initial consultation, anterior crowding, tooth crown morphology, and type of tooth movement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Invisalign ClinCheck predicted OGEs in adult patients treated with four premolar extractions. The accuracy of the prediction was satisfactory, 94% in the maxilla and 86% in the mandible, demonstrating great potential for clinical application.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2319\/091424-752.1","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T01:27:46Z","timestamp":1742261266000},"page":"389-396","source":"Crossref","is-referenced-by-count":2,"title":["Invisalign ClinCheck can predict open gingival embrasures in adult extraction cases: a pilot study"],"prefix":"10.2319","volume":"95","author":[{"given":"Feng","family":"Guo","sequence":"first","affiliation":[{"name":"Postgraduate Student, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenxu","family":"Wang","sequence":"additional","affiliation":[{"name":"Postgraduate Student, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Han","sequence":"additional","affiliation":[{"name":"Associate Chief Physician, Department of Orthodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houxuan","family":"Li","sequence":"additional","affiliation":[{"name":"Professor, Department of Periodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lang","family":"Lei","sequence":"additional","affiliation":[{"name":"Associate Professor, Department of Orthodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Mei","sequence":"additional","affiliation":[{"name":"Associate Professor, Discipline of Orthodontics, Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i1945-7103-95-4-389-b01","series-title":"Head Face Med","first-page":"30","article-title":"The incidence and severity of open gingival embrasures in adults treated with clear aligners and fixed appliances: a retrospective cohort study","volume":"19","author":"Yang","year":"2023","unstructured":"Yang T,Jiang L,Sun W, et al. The incidence and severity of open gingival embrasures in adults treated with clear aligners and fixed appliances: a retrospective cohort study. Head Face Med. 2023;19:30."},{"key":"i1945-7103-95-4-389-b02","series-title":"Aust Orthod J","first-page":"87","article-title":"Prediction and causes of open gingival embrasure spaces between the mandibular central incisors following orthodontic treatment","volume":"20","author":"Ikeda","year":"2004","unstructured":"Ikeda T,Yamaguchi M,Meguro D,Kasai K. Prediction and causes of open gingival embrasure spaces between the mandibular central incisors following orthodontic treatment. Aust Orthod J. 2004;20:87\u201392."},{"key":"i1945-7103-95-4-389-b03","series-title":"J Orofac Orthop","first-page":"365","article-title":"Invisalign\u00ae treatment in the anterior region: were the predicted tooth movements achieved","volume":"73","author":"Krieger","year":"2012","unstructured":"Krieger E,Seiferth J,Marinello I, et al. Invisalign\u00ae treatment in the anterior region: were the predicted tooth movements achieved? J Orofac Orthop. 2012;73:365\u2013376."},{"key":"i1945-7103-95-4-389-b04","series-title":"J Am Dent Assoc","first-page":"712","article-title":"Periodontal health during orthodontic treatment with clear aligners and fixed appliances: a meta-analysis","volume":"149","author":"Jiang","year":"2018","unstructured":"Jiang Q,Li J,Mei L, et al. Periodontal health during orthodontic treatment with clear aligners and fixed appliances: a meta-analysis. J Am Dent Assoc. 2018;149:712\u2013720.e712."},{"key":"i1945-7103-95-4-389-b05","series-title":"Aust Orthod J","first-page":"1","article-title":"Clear aligners brands and marketing claims: an overview of available information on the Web","volume":"38","author":"Shi","year":"2022","unstructured":"Shi C,Feng YL,Hsiao YC, et al. Clear aligners brands and marketing claims: an overview of available information on the Web. Aust Orthod J. 2022;38:1\u201311."},{"key":"i1945-7103-95-4-389-b06","series-title":"Eur J Orthod","first-page":"625","article-title":"Initial forces generated by three types of thermoplastic appliances on an upper central incisor during tipping","volume":"31","author":"Hahn","year":"2009","unstructured":"Hahn W,Fialka-Fricke J,Dathe H, et al. Initial forces generated by three types of thermoplastic appliances on an upper central incisor during tipping. Eur J Orthod. 2009;31:625\u2013631."},{"key":"i1945-7103-95-4-389-b07","series-title":"Am J Orthod Dentofacial Orthop","first-page":"506","article-title":"Incidence and size of pretreatment overlap and posttreatment gingival embrasure space between maxillary central incisors","volume":"105","author":"Burke","year":"1994","unstructured":"Burke S,Burch JG,Tetz JA. Incidence and size of pretreatment overlap and posttreatment gingival embrasure space between maxillary central incisors. Am J Orthod Dentofacial Orthop. 1994;105:506\u2013511."},{"key":"i1945-7103-95-4-389-b08","series-title":"Prog Orthod","first-page":"1","article-title":"IPR treatment and attachments design in clear aligner therapy and risk of open gingival embrasures in adults","volume":"24","author":"Zhang","year":"2023","unstructured":"Zhang Y,Wang X,Wang J, et al. IPR treatment and attachments design in clear aligner therapy and risk of open gingival embrasures in adults. Prog Orthod. 2023;24:1."},{"key":"i1945-7103-95-4-389-b09","series-title":"Br Dent J","article-title":"The use of radiographs to assess the impact of the distance between the contact area and the crest of the bone to predict the presence or absence of interdental papilla: an in vivo study","author":"Mahasneh","year":"2023","unstructured":"Mahasneh SA,Goodwin M,Pretty I,Cunliffe J. The use of radiographs to assess the impact of the distance between the contact area and the crest of the bone to predict the presence or absence of interdental papilla: an in vivo study. Br Dent J. 2023. doi:10.1038\/s41415-023-6184-z"},{"key":"i1945-7103-95-4-389-b10","series-title":"Angle Orthod","first-page":"145","article-title":"Does age influence deep overbite correction with Invisalign? A prospective study evaluating mandibular incisor intrusion in adolescents vs adults","volume":"94","author":"Kravitz","year":"2024","unstructured":"Kravitz ND,Hansa I,Vaid NR,Moshiri M,Adel SM. Does age influence deep overbite correction with Invisalign? A prospective study evaluating mandibular incisor intrusion in adolescents vs adults. 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Angle Orthod. 2018;88:267\u2013274."},{"key":"i1945-7103-95-4-389-b17","series-title":"Am J Orthod Dentofacial Orthop","first-page":"116","article-title":"Open gingival embrasures after orthodontic treatment in adults: prevalence and etiology","volume":"120","author":"Kurth","year":"2001","unstructured":"Kurth JR,Kokich VG. Open gingival embrasures after orthodontic treatment in adults: prevalence and etiology. Am J Orthod Dentofacial Orthop. 2001;120:116\u2013123."},{"key":"i1945-7103-95-4-389-b18","series-title":"Int J Periodontics Restorative Dent","first-page":"246","article-title":"Interdental papilla management: a review and classification of the therapeutic approaches","volume":"24","author":"Prato","year":"2004","unstructured":"Prato GP,Rotundo R,Cortellini P,Tinti C,Azzi R. Interdental papilla management: a review and classification of the therapeutic approaches. 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Invisalign\u00ae treatment in the anterior region: were the predicted tooth movements achieved? J Orofac Orthop. 2012;73:365\u2013376."},{"key":"i1945-7103-95-4-389-b04","series-title":"J Am Dent Assoc","first-page":"712","article-title":"Periodontal health during orthodontic treatment with clear aligners and fixed appliances: a meta-analysis","volume":"149","author":"Jiang","year":"2018","unstructured":"Jiang Q,Li J,Mei L, et al. Periodontal health during orthodontic treatment with clear aligners and fixed appliances: a meta-analysis. J Am Dent Assoc. 2018;149:712\u2013720.e712."},{"key":"i1945-7103-95-4-389-b05","series-title":"Aust Orthod J","first-page":"1","article-title":"Clear aligners brands and marketing claims: an overview of available information on the Web","volume":"38","author":"Shi","year":"2022","unstructured":"Shi C,Feng YL,Hsiao YC, et al. Clear aligners brands and marketing claims: an overview of available information on the Web. Aust Orthod J. 2022;38:1\u201311."},{"key":"i1945-7103-95-4-389-b06","series-title":"Eur J Orthod","first-page":"625","article-title":"Initial forces generated by three types of thermoplastic appliances on an upper central incisor during tipping","volume":"31","author":"Hahn","year":"2009","unstructured":"Hahn W,Fialka-Fricke J,Dathe H, et al. Initial forces generated by three types of thermoplastic appliances on an upper central incisor during tipping. Eur J Orthod. 2009;31:625\u2013631."},{"key":"i1945-7103-95-4-389-b07","series-title":"Am J Orthod Dentofacial Orthop","first-page":"506","article-title":"Incidence and size of pretreatment overlap and posttreatment gingival embrasure space between maxillary central incisors","volume":"105","author":"Burke","year":"1994","unstructured":"Burke S,Burch JG,Tetz JA. Incidence and size of pretreatment overlap and posttreatment gingival embrasure space between maxillary central incisors. Am J Orthod Dentofacial Orthop. 1994;105:506\u2013511."},{"key":"i1945-7103-95-4-389-b08","series-title":"Prog Orthod","first-page":"1","article-title":"IPR treatment and attachments design in clear aligner therapy and risk of open gingival embrasures in adults","volume":"24","author":"Zhang","year":"2023","unstructured":"Zhang Y,Wang X,Wang J, et al. IPR treatment and attachments design in clear aligner therapy and risk of open gingival embrasures in adults. Prog Orthod. 2023;24:1."},{"key":"i1945-7103-95-4-389-b09","series-title":"Br Dent J","article-title":"The use of radiographs to assess the impact of the distance between the contact area and the crest of the bone to predict the presence or absence of interdental papilla: an in vivo study","author":"Mahasneh","year":"2023","unstructured":"Mahasneh SA,Goodwin M,Pretty I,Cunliffe J. The use of radiographs to assess the impact of the distance between the contact area and the crest of the bone to predict the presence or absence of interdental papilla: an in vivo study. Br Dent J. 2023. doi:10.1038\/s41415-023-6184-z"},{"key":"i1945-7103-95-4-389-b10","series-title":"Angle Orthod","first-page":"145","article-title":"Does age influence deep overbite correction with Invisalign? A prospective study evaluating mandibular incisor intrusion in adolescents vs adults","volume":"94","author":"Kravitz","year":"2024","unstructured":"Kravitz ND,Hansa I,Vaid NR,Moshiri M,Adel SM. Does age influence deep overbite correction with Invisalign? A prospective study evaluating mandibular incisor intrusion in adolescents vs adults. 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Int J Periodontics Restorative Dent. 1997;17:326\u2013333."},{"key":"i1945-7103-95-4-389-b13","series-title":"Aust Orthod J","first-page":"19","article-title":"Some factors associated with open gingival embrasures following orthodontic treatment","volume":"19","author":"Ko-Kimura","year":"2003","unstructured":"Ko-Kimura N,Kimura-Hayashi M,Yamaguchi M, et al. Some factors associated with open gingival embrasures following orthodontic treatment. Aust Orthod J. 2003;19:19\u201324."},{"key":"i1945-7103-95-4-389-b14","series-title":"J Clin Periodontol","first-page":"570","article-title":"On the relationship between crown form and clinical features of the gingiva in adolescents","volume":"20","author":"Olsson","year":"1993","unstructured":"Olsson M,Lindhe J,Marinello CP. On the relationship between crown form and clinical features of the gingiva in adolescents. 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Angle Orthod. 2018;88:267\u2013274."},{"key":"i1945-7103-95-4-389-b17","series-title":"Am J Orthod Dentofacial Orthop","first-page":"116","article-title":"Open gingival embrasures after orthodontic treatment in adults: prevalence and etiology","volume":"120","author":"Kurth","year":"2001","unstructured":"Kurth JR,Kokich VG. Open gingival embrasures after orthodontic treatment in adults: prevalence and etiology. Am J Orthod Dentofacial Orthop. 2001;120:116\u2013123."},{"key":"i1945-7103-95-4-389-b18","series-title":"Int J Periodontics Restorative Dent","first-page":"246","article-title":"Interdental papilla management: a review and classification of the therapeutic approaches","volume":"24","author":"Prato","year":"2004","unstructured":"Prato GP,Rotundo R,Cortellini P,Tinti C,Azzi R. Interdental papilla management: a review and classification of the therapeutic approaches. 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