{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T02:49:17Z","timestamp":1780454957442,"version":"3.54.1"},"reference-count":49,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,9,11]],"date-time":"2022-09-11T00:00:00Z","timestamp":1662854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>This retrospective study evaluated changes in the pharyngeal portion of the upper airway in patients with constricted and normal airways treated with clear aligners (Invisalign, Align). Additionally, we assessed the change of tongue position in the oral cavity from a lateral view. Evaluation was performed with specialized software (Invivo 6.0, Anatomage) on pretreatment and post-treatment pairs of cone beam computed tomography imaging (CBCT) data. The level of airway constriction, volume, cross-section minimal area and tongue profile were evaluated. Patients with malocclusion, with pair or initial and finishing CBCT and without significant weight change between the scans, treated with Invisalign clear aligners were distributed into two groups. Group A consisted of fifty-five patients with orthodontic malocclusion and constricted upper airway. Control group B consisted of thirty-one patients with orthodontic malocclusions without any airway constriction. In the group with airway constriction there was a statistically significant increase in volume during therapy (p &lt; 0.001). The surface of the most constricted cross-section of the airway did not change significantly after treatment in any of the groups. The final tongue position was different from the initial position in 62.2% of all clear aligner treatments. The position of the smallest clearance of the airway in the pharynx was similar for both groups localized at the level of 2nd cervical vertebra.<\/jats:p>","DOI":"10.3390\/diagnostics12092201","type":"journal-article","created":{"date-parts":[[2022,9,12]],"date-time":"2022-09-12T20:52:25Z","timestamp":1663015945000},"page":"2201","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Change in the Constricted Airway in Patients after Clear Aligner Treatment: A Retrospective Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5810-2793","authenticated-orcid":false,"given":"Georgia","family":"Fountoulaki","sequence":"first","affiliation":[{"name":"Department of Stomatology and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava, 81250 Bratislava, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7810-5721","authenticated-orcid":false,"given":"Andrej","family":"Thurzo","sequence":"additional","affiliation":[{"name":"Department of Stomatology and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava, 81250 Bratislava, Slovakia"},{"name":"Department of Simulation and Virtual Medical Education, Faculty of Medicine, Comenius University in Bratislava, Sasinkova 4, 81272 Bratislava, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1415.e1","DOI":"10.1016\/j.joms.2020.03.024","article-title":"Is There a Correlation Between Airway Volume and Maximum Constriction Area Location in Different Dentofacial Deformities?","volume":"78","author":"Albright","year":"2020","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1111\/j.1601-6343.2008.00431.x","article-title":"Reliability of Cranial Base Measurements on Lateral Skull Radiographs","volume":"11","author":"Arponen","year":"2008","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/j.ajodo.2012.12.011","article-title":"Impact of Cone-Beam Computed Tomography on Orthodontic Diagnosis and Treatment Planning","volume":"143","author":"Hodges","year":"2013","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1007\/s11325-012-0799-7","article-title":"CBCT Assessment of Upper Airway Changes and Treatment Outcomes of Obstructive Sleep Apnoea: A Systematic Review","volume":"17","author":"Alsufyani","year":"2013","journal-title":"Sleep Breath."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Milenkovic, J., Vasiljevic, M., Jovicic, N., Milovanovic, D., Selakovic, D., and Rosic, G. (2022). Criteria for the Classification of the Interradicular Septum Shape in Maxillary Molars with Clinical Importance for Prosthetic-Driven Immediate Implant Placement. Diagnostics, 12.","DOI":"10.3390\/diagnostics12061432"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Pavlovic, Z.R., Milanovic, P., Vasiljevic, M., Jovicic, N., Arnaut, A., Colic, D., Petrovic, M., Stevanovic, M., Selakovic, D., and Rosic, G. (2022). Assessment of Maxillary Molars Interradicular Septum Morphological Characteristics as Criteria for Ideal Immediate Implant Placement\u2014The Advantages of Cone Beam Computed Tomography Analysis. Diagnostics, 12.","DOI":"10.3390\/diagnostics12041010"},{"key":"ref_7","first-page":"168","article-title":"The WEB 2.0 Induced Paradigm Shift in the e-Learning and the Role of Crowdsourcing in Dental Education","volume":"111","author":"Thurzo","year":"2010","journal-title":"Bratisl. Lek. Listy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1016\/j.joms.2017.09.006","article-title":"Computed Tomography Characterization and Comparison with Polysomnography for Obstructive Sleep Apnea Evaluation","volume":"76","author":"Chousangsuntorn","year":"2018","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"508","DOI":"10.3348\/jksr.2022.0044","article-title":"MRI Findings in Parkinson\u2019s Disease: Radiologic Assessment of Nigrostriatal Degeneration","volume":"83","author":"Bae","year":"2022","journal-title":"J. Korean Soc. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.joms.2009.09.086","article-title":"Three-Dimensional Computed Tomographic Analysis of Airway Anatomy","volume":"68","author":"Abramson","year":"2010","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"306.e1","DOI":"10.1016\/j.ajodo.2009.10.025","article-title":"Three-Dimensional Analysis of Pharyngeal Airway in Preadolescent Children with Different Anteroposterior Skeletal Patterns","volume":"137","author":"Kim","year":"2010","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1016\/j.ajodo.2007.04.043","article-title":"Comparison of Airway Space with Conventional Lateral Headfilms and 3-Dimensional Reconstruction from Cone-Beam Computed Tomography","volume":"135","author":"Aboudara","year":"2009","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_13","unstructured":"Scheuer, C., Boot, E., Carse, N., Clardy, A., Gallagher, J., Heck, S., Marron, S., Mart\u00ednez-Alvarez, L., Masarykova, D., and McMillan, P. (2021). Disentangling Inclusion in Physical Education Lessons: Developing a Resource Toolkit for Teachers. Phys. Educ. Sport Child. Youth Spec. NeedsRes. Best Pract. Situat., 343\u2013354."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1590\/S1806-83242013000100009","article-title":"Reliability of a Method to Conduct Upper Airway Analysis in Cone-Beam Computed Tomography","volume":"27","author":"Souza","year":"2013","journal-title":"Braz. Oral Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/j.ajodo.2016.03.024","article-title":"When Static Meets Dynamic: Comparing Cone-Beam Computed Tomography and Acoustic Reflection for Upper Airway Analysis","volume":"150","author":"Tsolakis","year":"2016","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_16","first-page":"91","article-title":"Control of Upper Airway Motoneurons during REM Sleep","volume":"13","author":"Kubin","year":"1998","journal-title":"News Physiol. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1093\/brain\/awab026","article-title":"Sleep Essentialism","volume":"144","author":"Walker","year":"2021","journal-title":"Brain"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s40675-021-00218-x","article-title":"Pathophysiology of Obstructive Sleep Apnea in Aging Women","volume":"7","author":"Qiu","year":"2021","journal-title":"Curr. Sleep Med. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1148\/radiol.2017162486","article-title":"Loss of Substantia Nigra Hyperintensity at 3.0-T MR Imaging in Idiopathic REM Sleep Behavior Disorder: Comparison with 123I-FP-CIT SPECT","volume":"287","author":"Bae","year":"2018","journal-title":"Radiology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1093\/sleep\/32.9.1173","article-title":"Upper Airway Collapsibility During REM Sleep in Children with the Obstructive Sleep Apnea Syndrome","volume":"32","author":"Huang","year":"2009","journal-title":"Sleep"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1111\/j.1469-7793.1998.00963.x","article-title":"The Effect of Rapid Eye Movement (REM) Sleep on Upper Airway Mechanics in Normal Human Subjects","volume":"510","author":"Rowley","year":"1998","journal-title":"J. Physiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.jdsr.2011.12.003","article-title":"Tongue and Upper Airway Function in Subjects with and without Obstructive Sleep Apnea","volume":"48","author":"Ono","year":"2012","journal-title":"Jpn. Dent. Sci. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Zota, I.M., St\u0103tescu, C., Sasc\u0103u, R.A., Roca, M., Gavril, R.S., Vasilcu, T.F., Boi\u0219teanu, D., Ma\u0219taleru, A., Jitaru, A., and Leon Constantin, M.M. (2020). CPAP Effect on Cardiopulmonary Exercise Testing Performance in Patients with Moderate-Severe OSA and Cardiometabolic Comorbidities. Medicina, 56.","DOI":"10.3390\/medicina56020080"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/S2213-2600(15)00043-0","article-title":"Prevalence of Sleep-Disordered Breathing in the General Population: The HypnoLaus Study","volume":"3","author":"Heinzer","year":"2015","journal-title":"Lancet Respir. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1016\/S0140-6736(13)60734-5","article-title":"Adult Obstructive Sleep Apnoea","volume":"383","author":"Jordan","year":"2014","journal-title":"Lancet"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Santilli, M., Manciocchi, E., D\u2019Addazio, G., Di Maria, E., D\u2019Attilio, M., Femminella, B., and Sinjari, B. (2021). Prevalence of Obstructive Sleep Apnea Syndrome: A Single-Center Retrospective Study. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph181910277"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"20150085","DOI":"10.1259\/dmfr.20150085","article-title":"Lateral Teleradiography of the Head as a Diagnostic Tool Used to Predict Obstructive Sleep Apnea","volume":"45","author":"Armalaite","year":"2016","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Mathiyalagen, P., Govindasamy, V., Rajagopal, A., Vasudevan, K., Gunasekaran, K., and Yadav, D. (2019). Magnitude and Determinants of Patients at Risk of Developing Obstructive Sleep Apnea in a Non-Communicable Disease Clinic. Medicina, 55.","DOI":"10.3390\/medicina55070391"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Ardelean, C.L., Pescariu, S., Lighezan, D.F., Pleava, R., Ursoniu, S., Nadasan, V., and Mihaicuta, S. (2019). Particularities of Older Patients with Obstructive Sleep Apnea and Heart Failure with Mid-Range Ejection Fraction. Medicina, 55.","DOI":"10.3390\/medicina55080449"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Alexandropoulou, A., Vavougios, G.D., Hatzoglou, C., Gourgoulianis, K.I., and Zarogiannis, S.G. (2019). Risk Assessment for Self Reported Obstructive Sleep Apnea and Excessive Daytime Sleepiness in a Greek Nursing Staff Population. Medicina, 55.","DOI":"10.3390\/medicina55080468"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Celik, Y., Yapici-Eser, H., Balcan, B., and Peker, Y. (2021). Association of Excessive Daytime Sleepiness with the Zung Self-Rated Depression Subscales in Adults with Coronary Artery Disease and Obstructive Sleep Apnea. Diagnostics, 11.","DOI":"10.3390\/diagnostics11071176"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Hsieh, H.-S., Kang, C.-J., Chuang, H.-H., Zhuo, M.-Y., Lee, G.-S., Huang, Y.-S., Chuang, L.-P., Kuo, T.B.-J., Yang, C.C.-H., and Lee, L.-A. (2021). Screening Severe Obstructive Sleep Apnea in Children with Snoring. Diagnostics, 11.","DOI":"10.3390\/diagnostics11071168"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Dragonieri, S., and Bikov, A. (2020). Obstructive Sleep Apnea: A View from the Back Door. Medicina, 56.","DOI":"10.3390\/medicina56050208"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Celikhisar, H., and Dasdemir Ilkhan, G. (2019). The Association of Obstructive Sleep Apnea Syndrome and Accident Risk in Heavy Equipment Operators. Medicina, 55.","DOI":"10.3390\/medicina55090599"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Thurzo, A., Urbanov\u00e1, W., Nov\u00e1k, B., Czako, L., Siebert, T., Stano, P., Marekov\u00e1, S., Fountoulaki, G., Kosn\u00e1\u010dov\u00e1, H., and Varga, I. (2022). Where Is the Artificial Intelligence Applied in Dentistry? Systematic Review and Literature Analysis. Healthcare, 10.","DOI":"10.3390\/healthcare10071269"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Thurzo, A., Urbanov\u00e1, W., Nov\u00e1k, B., Waczul\u00edkov\u00e1, I., and Varga, I. (2022). Utilization of a 3D Printed Orthodontic Distalizer for Tooth-Borne Hybrid Treatment in Class II Unilateral Malocclusions. Materials, 15.","DOI":"10.3390\/ma15051740"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/j.ajodo.2016.05.013","article-title":"Effect of Orthodontic Treatment on the Upper Airway Volume in Adults","volume":"150","author":"Pliska","year":"2016","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"115","DOI":"10.2319\/011011-13.1","article-title":"Changes of Pharyngeal Airway Size and Hyoid Bone Position Following Orthodontic Treatment of Class I Bimaxillary Protrusion","volume":"82","author":"Wang","year":"2012","journal-title":"Angle Orthod."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/S0889-5406(96)70123-3","article-title":"Cephalometric Assessment in Obstructive Sleep Apnea","volume":"109","author":"Pracharktam","year":"1996","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"284","DOI":"10.3390\/clinpract12030034","article-title":"Correlation of Medical Comorbidities and Upper Airway Measurements among Dental Patients at Risk of Developing Obstructive Sleep Apnea","volume":"12","author":"Lin","year":"2022","journal-title":"Clin. Pract."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.ajodo.2014.10.018","article-title":"CBCT Volumetric Analyses Have No Value in Assessing Functional Airway","volume":"147","author":"Antosz","year":"2015","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Braun, M.J., Rauneker, T., Dreyhaupt, J., Hoffmann, T.K., Luthardt, R.G., Schmitz, B., Dammann, F., and Beer, M. (2022). Dental and Maxillofacial Cone Beam CT\u2014High Number of Incidental Findings and Their Impact on Follow-Up and Therapy Management. Diagnostics, 12.","DOI":"10.3390\/diagnostics12051036"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Shujaat, S., Shaheen, E., Riaz, M., Politis, C., and Jacobs, R. (2022). Three-Dimensional Pharyngeal Airway Space Changes Following Isolated Mandibular Advancement Surgery in 120 Patients: A 1-Year Follow-up Study. J. Imaging, 8.","DOI":"10.3390\/jimaging8040082"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez Men\u00e9ndez, H., Rodr\u00edguez Torres, P., Mu\u00f1oz Jim\u00e9nez, B., Galparsoro Catal\u00e1n, A., Velasco Boh\u00f3rquez, P., Tzironi, G., San Hip\u00f3lito Mar\u00edn, L., Zubizarreta Macho, \u00c1., and Hern\u00e1ndez Montero, S. (2021). A Replicable and Reproducible Digital Method for Quantifying Maxillary Sinus Airway Changes after Sinus Lifts Using the Lateral Window Approach Technique\u2014A Retrospective Study. J. Pers. Med., 11.","DOI":"10.3390\/jpm11111093"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Diwakar, R., Kochhar, A.S., Gupta, H., Kaur, H., Sidhu, M.S., Skountrianos, H., Singh, G., and Tepedino, M. (2021). Effect of Craniofacial Morphology on Pharyngeal Airway Volume Measured Using Cone-Beam Computed Tomography (CBCT)\u2014A Retrospective Pilot Study. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18095040"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/j.ajodo.2014.12.023","article-title":"Postsurgical Volumetric Airway Changes in 2-Jaw Orthognathic Surgery Patients","volume":"147","author":"Hart","year":"2015","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_47","first-page":"154","article-title":"Novel 3D Segmentation for Reliable Volumetric Assessment of the Nasal Airway: A CBCT Study","volume":"52","author":"Mupparapu","year":"2021","journal-title":"Quintessence Int."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Abdelkarim, A. (2019). Cone-Beam Computed Tomography in Orthodontics. Dent. J., 7.","DOI":"10.3390\/dj7030089"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Thurzo, A., Urbanov\u00e1, W., Waczul\u00edkov\u00e1, I., Kurilov\u00e1, V., Mri\u0148\u00e1kov\u00e1, B., Kosn\u00e1\u010dov\u00e1, H., G\u00e1lis, B., Varga, I., Matajs, M., and Nov\u00e1k, B. (2022). Dental Care and Education Facing Highly Transmissible SARS-CoV-2 Variants: Prospective Biosafety Setting: Prospective, Single-Arm, Single-Center Study. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19137693"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/9\/2201\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:29:27Z","timestamp":1760142567000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/9\/2201"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,11]]},"references-count":49,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["diagnostics12092201"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics12092201","relation":{"has-preprint":[{"id-type":"doi","id":"10.20944\/preprints202207.0454.v1","asserted-by":"object"}]},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,11]]}}}