Date of Award



Department of Orthodontics

First Advisor

Heesoo Oh

First Committee Member

James Chen


Introduction: Orthodontic and orthopedic expansion is necessary to create space to resolve crowding due to arch deficiency or tooth size discrepancy. The Invisalign First clear aligner appliance as a modality for early interceptive orthodontic treatment has become incorporated into orthodontic practices in very recent years. The present study aims to investigate the magnitude of expansion of the Invisalign First clear aligner appliance compared to a Schwartz removable expander in patients with mixed dentition. Additionally, the study aims to compare the efficacy and predictability of Invisalign First clear aligners in this population. Materials & Methods: In this retrospective study, a sample was collected from a single orthodontist practitioner. The sample consisted of 34 patients, 16 patients treated with Invisalign First clear aligners only (Group1) and 19 patients treated with a Schwartz removable appliance and Invisalign First clear aligners (Group 2). Intraoral scans of four timepoints, initial (T1), post-expansion for Group 2 only (T1Exp), first refinement (T2), and final (T3), and planned Clincheck goal (P) model from Clincheck software were imported to Align Technology’s digital measure program (Quantify©). Arch widths and molar inclinations were measured at each timepoint and the changes between timepoints were calculated. Predictability of arch expansion was calculated as T13 (change between initial and final) divided by the Planned dimension multiplied by one hundred. A two sample t-test was used to assess differences in the changes in arch widths and predictability of expansion between two groups. Results: There were statistically significant differences found in the magnitude of expansion and predictability of arch expansion between two groups. Group 2 showed a greater amount of expansion and predictability. Group 1 showed about 50-60% of the planned expansion at the end of treatment. In regards to magnitude of expansion when comparing the two groups, the efficacy predictability of transverse dimensional changes were significantly greater in the Group 2 compared to Group 1, 83% vs 56% (p = 0.001), respectively. The changes in inclination were similar in both groups, with no statistically significant differences.Conclusions: There is a significantly greater amount of expansion and greater predictability with the Schwartz removable appliance compared to the Invisalign First clear aligner appliance in the mixed dentition. The predictability of Invisalign First was 56% and indicates a significant overcorrection of arch expansion is required at the virtual treatment planning stage in Clincheck in order to obtain the arch expansion that was planned