Orthodontic treatment by custom-made aligners in patients with Juvenile Idiopathic Arthritis

Aim: The aim of this work is to demonstrate how the orthodontic treatment with custom-made aligners can provide aesthetic and functional good results in patients with Juvenile Idiopathic Arthritis (JIA). Materials and Methods: Patients with JIA who needed dental alignment were selected at the Department of Orthodontics of the University of Milan to be treated with aligners. Five patients are still under treatment and only two have finished it. This last underwent therapy from February 2006 - January 2016. He was initially treatments for patients with JIA – until the end of growth. At the age of 15, he presented both skeletal and dental Class I and dental crowding. The orthodontic treatment has continued with use of Smart Track aligners. Initial dental records were sent to Company headquarters to make Clin Check (a 3D simulation visualizing final results before therapy starts). Once received and analyzed, our Department asks to improve some aspects, including mandibular crowding with not excessive proclination of 31 and harmonic alignment of both arches. After treatment confirmed, all 16 aligners in total were received plus a clear plastic template – looks a lot like a regular aligner, with the exception that is has small bulges where attachment need to be placed. Each aligner was held in situ for a period of two weeks. During the treatment, stripping of the lower front teeth was applied to obtain space equal to 1.4 mm. at the end of the treatment, orthodontic retainers were applied. Results: After last aligner, the patient presented dental and skeletal Class I, with maxillary and mandibular good alignment. During the whole period of treatment, she never complained of joint pain nor showed exacerbation of JIA. Objective clinical examination showed no signs of condylar distress. Conclusions: The use of aligners allows to obtain a good alignment even in complicated therapy of patients with JIA. They alternate indeed periods of joint inflammation and quiescence. A standard therapy with a straight-wire appliance can worsen the underway inflammatory joint state. On the contrary, the use of aligners produces equivalent results without incurring this additional risk.