Author ORCID Identifier
https://orcid.org/0009-0000-6851-1622
Defense Date
2026
Document Type
Thesis
Degree Name
Master of Science in Dentistry
Department
Dentistry
First Advisor
Christina Philips
Second Advisor
Steven Lindauer
Third Advisor
Bhavna Shroff
Fourth Advisor
Caroline Carrico
Fifth Advisor
Parthasarthy Madurantakam
Abstract
Objective: Predictable maxillary lateral incisor extrusion with clear aligners remains a clinical challenge. Clinicians often select attachment design based on anecdotal experience rather than prospective evidence. This multicenter randomized controlled trial compared the clinical efficacy of Invisalign optimized extrusion attachments against three sizes of horizontal gingivally-beveled attachments (1×1×3 mm, 1×1×4 mm, 1×1×5 mm) and evaluated patient esthetic perceptions of each.
Methods: Patients requiring at least 0.5 mm of maxillary lateral incisor extrusion were recruited across four clinical sites. Targeted incisors were randomized into four groups: Optimized (O), or Horizontal 3mm (H3), 4mm (H4), and 5mm (H5). Digital models (Pretreatment, Predicted, and Posttreatment) were superimposed using Geomagic software to quantify extrusion accuracy. Patient esthetic satisfaction was captured via a REDCap survey using a 5-point Likert scale.
Results: Thirty-one teeth from 18 patients were analyzed. Achieved extrusion was significantly lower than predicted, with a median of 70% of planned movement. Optimized attachments produced significantly greater extrusion than horizontal gingivally beveled attachments (92% vs. 52%; p=0.0108), while no significant differences were observed among horizontal attachment sizes. Survey results indicated high esthetic satisfaction across all cohorts. No statistically significant differences in esthetic perception were observed between attachment designs.
Conclusion: Optimized extrusion attachments significantly outperformed horizontal gingivally beveled attachments, achieving greater extrusion efficiency without compromising esthetics. Increasing horizontal attachment size did not improve extrusion outcomes. Optimized attachments are therefore recommended for maxillary lateral incisor extrusion with Invisalign.
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
5-29-2026