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Invisalign Transparency

As the new Editor-in-Chief, I am frequently asked about my vision for JCO moving forward. Perhaps the most notable change with regard to content will be an increase in case reports and technique articles on clear aligner treatment (CAT), particularly Invisalign. As Invisalign takes a larger role in orthodontic practices—the current estimate is 25% of the total caseload in the United States—it is imperative that our journal continue to position itself at the forefront of CAT clinical education.

In fact, over the past two decades, JCO has published a number of landmark Invisalign articles. For example, Boyd and colleagues wrote the very first Invisalign case report1; Owen was the first to describe accelerated Invisalign treatment using corticotomies2; Boyd was the first to report on the combination of Invisalign treatment with orthognathic surgery3; and Hamula and Brewka introduced the concept of an Invisalign-only practice.4 I vividly remember reading all these articles as a wide-eyed resident.

JCO has also led the way in presenting CAT hybrid mechanics. Eckhart was the first to describe Invisalign following a Mandibular Anterior Repositioning Appliance (MARA),5 which is an approach I use every day in my practice. Giancotti and Di Girolamo described the use of partial fixed appliances prior to Invisalign in an extraction case.6 In one of my favorite articles, Wilmes and colleagues used a skeletally supported distalizer simultaneously with Invisalign.7 Most recently, Lombardo and colleagues placed lingual fixed appliances beneath overlay aligners.8

Regarding future publications, I have invited some of our leading Invisalign clinicians to write about aligner biomechanics. What I am looking for in particular is explicit instructions. Perhaps the perfect example is Nicozisis’s Pearl on the “sash” attachment for upper lateral-­incisor rotation, which remains one of JCO’s most popular articles.9 In the current issue, we are excited to publish a clinical study by Glaser and colleagues on the use of Invisalign’s mandibular-advancement (MA) feature with Precision Wings, as well as two other articles focusing on the MA protocol.

When we receive the next beautiful case-­report submission on Invisalign treatment, I will ask the authors to include their detailed ClinCheck instructions, because I want to know what is happening between each series of photographs. The days of authors merely showcasing the possibilities of Invisalign have passed; future articles must teach technique and be honest about limitations. Simply put, clear aligner treatment must be more transparent.

Above all, my goal is for JCO to set the bar high for Invisalign education. This means accepting only those papers with proper case selection, complete records, rationale for attachments, and explanation of biomechanics, and it also means holding authors accountable for writing factual statements. Invisalign may not be replacing braces anytime soon, but it is an amazing tool when used appropriately. The future for JCO is bright, and I can see it clearly.



  • 1.   Boyd, R.L.; Miller, R.J.; and Vlaskalic, V.: The Invisalign system in adult orthodontics: Mild crowding and space closure cases, J. Clin. Orthod. 34:203-212, 2000.
  • 2.   Owen, A.H. III: Accelerated Invisalign treatment, J. Clin. Orthod. 35:381-384, 2001.
  • 3.   Boyd, R.L.: Surgical-orthodontic treatment of two skeletal Class III patients with Invisalign and fixed appliances, J. Clin. Orthod. 39:245-258, 2005.
  • 4.   Hamula, W. and Brewka, R.E.: Orthodontic Office Design: The Invisalign office, J. Clin. Orthod. 39:259-263, 2005.
  • 5.   Eckhart, J.E.: Sequential MARA-Invisalign treatment, J. Clin. Orthod. 43:439-448, 2009.
  • 6.   Giancotti, A. and Di Girolamo, R.: Treatment of severe maxillary crowding using Invisalign and fixed appliances, J. Clin. Orthod. 43:583-589, 2009.
  • 7.   Wilmes, B.; Schwarze, J.; Vasudavan, S.; and Drescher, D.: Combination of clear aligners and Beneslider for correction of severe midline deviation, J. Clin. Orthod. 55:675-683, 2021.
  • 8.   Lombardo, L.; Pepe, F.; Carlucci, A.; and Cremonini, F.: A hybrid approach to clear aligner therapy in lower-incisor extraction cases, J. Clin. Orthod. 55:211-220, 2022.
  • 9.   Nicozisis, J.: Attachment beauty queen: The “sash” for rotation correction of upper lateral incisors, J. Clin. Orthod. 50:189-190, 2016.



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