Dental Asia January/February 2019

Clinical Feature
brushing, flossing and eating which
promotes better oral hygiene. Aligners
are clear, aesthetically pleasing and
comfortable – with no metal brackets or
wires that may cause irritation. Teeth can
also be whitened with the appliance during
treatment. Other recorded advantages
include shortened appointment times,
decreased allergic responses, decreased
occlusal abrasion from parafunctional
habits during treatment, facilitation of
aligner retention, disarticulation of teeth
which may be advantageous for patients
with TMJ problems, it being technically
much easier to use as compared to lingual
appliances and the ability to present
the final results to the patient prior to
treatment.
However, there is a lack of operator control
and the inability to integrate hard and
soft tissues of the head into the computer
treatment and clinicians have no direct
indication of where teeth are in relation to
the basal bone or in relation to lips or other
soft tissues of the head. 6
Boyd reported that aligner users who
are teens showed improved periodontal
status compared to patients with fixed
appliances. 7 Patients are able to remove
the aligners when they eat drink or
brush. Several studies indicate that the
periodontal status improved after active
orthodontic treatment with aligners due
to the correction of crowding. Additionally,
stripping can also improve the periodontal
status by restoring adequate space to the
gingival papilla. 2
The Nuvola System
The Nuvola clear aligner from Italy was
launched in 2010 as an alternative to
traditional orthodontic appliances. Already
a well-established brand in Germany,
Romania, Bulgaria and UK markets, Nuvola
is continuing to expand its reach, having
penetrated the Asian market recently.
Nuvola is a transparent aligner system
designed to achieve gradual straightening
of the teeth and correct overcrowding. The
aligners allow mesial, distal, intrusion,
extrusion and tipping-torque movements
in order to achieve aesthetic and
unobtrusive results. The aligners also
enable interdental spaces to be closed or
space to be created for implants.
Nuvola aligners are made from a unique
material specifically designed to optimise
the correct alignment of teeth. Strong,
flexible, stain resistant and transparent,
Nuvola aligners follow the morphology
of the teeth and allow for consistent
application of gentle forces that move
teeth progressively. They must be worn at
least 20 hours daily for two weeks before
being replaced by the next aligner to allow
for progressive change.
There are 12 progressive aligners per stage
that provide strong and precise control
at all times. Ercoli in 2014 evaluated
the efficiency of the Nuvola system in
controlling torque movement of the
upper and lower anterior. He found that
the system was able to produce clinical
outcomes comparable to the planning of
the digital setup for moderate crowding
cases (up to 6 mm). 2
In 2018, Tepedino investigated 39
adult patients wearing only 12 Nuvola
aligners and found the clinical outcomes
were comparable to the digital setup
planning of anterior torque movements.
Levelling, aligning, intrusion and
bodily distalisation of upper molars
(