A comparison of SureSmile^TM, Insignia^TM, and Invisalign^TM, in treating non-extraction cases of mild to moderate crowding: a prospective clinical trial

Figure 1.

Gender and Treatment Group Crosstabulation for arches used for objective grading scores_

	Treatment group
	Insignia	Invisalign	SureSmile	Total
Sex
Male
Count	20	10	22	52
% within Female Gender	38.5%	19.2%	42.3%	100.0%
% within Treatment Group	58.8%	23.8%	44.0%	41.3%
% of Total	15.9%	7.9%	17.5%	41.3%
Female
Count	14	32	28	74
% within Female Gender	18.9%	43.2%	37.8%	100.0%
% within Treatment Group	41.2%	76.2%	56.0%	58.7%
% of Total	11.1%	25.4%	22.2%	58.7%
Total
Count	34	42	50	126
% within Female Gender	27.0%	33.3%	39.7%	100.0%
% within Treatment Group	100.0%	100.0%	100.0%	100.0%
% of Total	27.0%	33.3%	39.7%	100.0%

Lower and upper arch age distribution (years)_

Treatment group	Mean	Median	SD
Lower arch
Insignia	13.9	14	1.4
Invisalign	29.1	28	10.2
SureSmile	16.5	14	7.5
Upper arch
Insignia	14	14	1.4
Invisalign	29.1	28	10.2
SureSmile	16.5	14	7.5

Mann-Whitney Test comparing the Invisalign outcomes between the two offices_ Only landmarks with significant differences included_ Remaining non significant landmarks in supplementary table C_

Landmark	Mann-Whitney U	Wilcoxon W	Z	p-value
Upper left canine cusp x_Actual_Goal	39	105	-2.564	0.01
Upper right first premolar B cusp z_Actual_Goal	23	68	-2.774	0.006
Lower left first molar DB cusp y_Actual_Goal	33	99	-2.846	0.004
Lower right first premolar DMR y_Actual_Goal	36	102	-2.566	0.01
Lower right second premolar DMR y_Actual_Goal	27	93	-3.128	0.002
Lower left second premolar DMR z_Actual_Goal	39	105	-2.564	0.01

Lower and upper arch inital crowding/spacing (positive value indicates crowding in mm)_

Treatment group	Mean crowding (mm)	Median	SD
Lower arch
Insignia	2.0188	2.25	1.0742
Invisalign	2.8318	2.83	1.99914
SureSmile	2.207	1.92	1.47366
Upper arch
Insignia	2.4261	2.415	1.73217
Invisalign	2.7546	2.5	1.60262
SureSmile	2.7359	2.42	1.54442

Intermolar and intercanine mean target width and SD by intervention_

System	Mean target intercanine width (mm )	Target intercanine width standard deviation	Mean target inter molar width at first molars (mm)	Target intermolar width standard deviation
Insignia	27.53	1.06	54.92	2.21
Invisalign	25.39	1.696	51.12	3.41
Suresmile	26.34	1.18	52.33	2.53

Objective Grading Score (OGS) descriptive statistics for each treatment category_

Treatment Group	Alignment/Rotations	Marginal Ridges	Buccolingual Inclination	Total OGS Score	Age
Insignia
Mean	2.56	.91	1.56	5.03	14
Std. Deviation	1.260	1.026	1.673	1.800	1.393
Percentile: 50	2.00	1.00	1.00	4.50	14.00
Invisalign
Mean	3.26	.38	2.21	5.83	30.48
Std. Deviation	1.499	.795	1.920	2.626	13.74
Percentile: 50	3.00	.00	2.00	6.00	25.00
SureSmile
Mean	1.98	.66	2.40	5.02	16.16
Std. Deviation	1.059	.895	2.157	2.386	7.536
Percentile: 50	2.00	.00	2.00	5.00	14.00

Ranges of mean difference between predicted and actual loctions of Anterior & Posterior Landmarks_

	Transverse difference (X)	Sagittal difference (Y)	Vertical difference (Z)
Insignia
Upper Anterior	0.27–0.48 mm	0.42–0.81 mm	0.33–0.57 mm
Upper Posterior	0.47–1.27 mm	1.15–2.22 mm	0.26–0.61 mm
Lower Anterior	0.31–0.50 mm	0.28–0.43 mm	0.36–0.57 mm
Lower Posterior	0.40–1.01 mm	0.40–0.81 mm	0.27–0.57 mm
Suresmile
Upper Anterior	0.21–0.56 mm	0.32–0.68 mm	0.33–0.63 mm
Upper Posterior	0.30–0.84 mm	0.28–0.63 mm	0.31–0.62 mm
Lower Anterior	0.16–0.44 mm	0.30–0.46 mm	0.29–0.47 mm
Lower Posterior	0.30–0.80 mm	0.40–0.70 mm	0.28–0.58 mm
Invisalign
Upper Anterior	0.23–0.45 mm	0.32–0.45 mm	0.31–0.60 mm
Upper Posterior	0.26–0.50 mm	0.18–0.41 mm	0.17–0.48 mm
Lower Anterior	0.13–0.37 mm	0.29–0.52 mm	0.34–0.51 mm
Lower Posterior	0.28–1.0 mm	0.47–0.83 mm	0.18–0.46 mm

Multiple pair-wise comparisons of mean differences betwee the predicted and actual location of each landmark_

Landmark	Reference system	Comparison system	Mean difference	Std. error	P value
Upper right first molar DB cusp x_Actual_Goal	Insignia	Invisalign	0.709	0.174	0.000
		SureSmile	0.449	0.175	0.037
Upper right first molar DMR x_Actual_Goal	Insignia	Invisalign	0.892	0.170	0.000
		SureSmile	0.435	0.171	0.039
Upper right first molar MMR x_Actual_Goal	Insignia	Invisalign	0.666	0.156	0.000
		SureSmile	0.521	0.157	0.004
Upper right second premolar B cusp x_Actual_Goal	Insignia	Invisalign	0.536	0.135	0.001
		SureSmile	0.359	0.136	0.031
Upper right second premolar DMR x_Actual_Goal	Insignia	Invisalign	0.738	0.160	0.000
		SureSmile	0.650	0.161	0.000
Upper right second premolar MMR x_Actual_Goal	Insignia	Invisalign	0.504	0.121	0.000
		SureSmile	0.413	0.122	0.003
Upper left first molar DB cusp x_Actual_Goal	Insignia	Invisalign	0.512	0.157	0.005
		SureSmile	0.257	0.158	0.326
Upper left first molar DMR x_Actual_Goal	Insignia	Invisalign	0.526	0.157	0.004
		SureSmile	0.294	0.158	0.203
Upper right first molar DB cusp y_Actual_Goal	Insignia	Invisalign	1.825	0.214	0.000
		SureSmile	1.788	0.215	0.000
Upper right first molar MB cusp y_Actual_Goal	Insignia	Invisalign	1.660	0.206	0.000
		SureSmile	1.650	0.207	0.000
Upper right first molar DMR y_Actual_Goal	Insignia	Invisalign	1.665	0.204	0.000
		SureSmile	1.612	0.206	0.000
Upper right first molar MMR y_Actual_Goal	Insignia	Invisalign	1.770	0.194	0.000
		SureSmile	1.736	0.196	0.000
Upper right second premolar B cusp y_Actual_Goal	Insignia	Invisalign	1.534	0.195	0.000
		SureSmile	1.346	0.197	0.000
Upper right second premolar DMR y_Actual_Goal	Insignia	Invisalign	1.429	0.179	0.000
		SureSmile	1.399	0.180	0.000
Upper right second premolar MMR y_Actual_Goal	Insignia	Invisalign	1.364	0.178	0.000
		SureSmile	1.359	0.179	0.000
Upper right first premolar B cusp y_Actual_Goal	Insignia	Invisalign	1.103	0.210	0.000
		SureSmile	0.906	0.208	0.000
Upper right first premolar DMR y_Actual_Goal	Insignia	Invisalign	1.114	0.168	0.000
		SureSmile	1.011	0.166	0.000
Upper right first premolar MMR y_Actual_Goal	Insignia	Invisalign	1.064	0.153	0.000
		SureSmile	0.978	0.151	0.000
Upper right canine disto-incisal y_Actual_Goal	Insignia	Invisalign	0.668	0.143	0.000
		SureSmile	0.591	0.144	0.000
Upper left canine disto-incisal y_Actual_Goal	Insignia	Invisalign	0.691	0.134	0.000
		SureSmile	0.545	0.135	0.000
Upper left first premolar B cusp y_Actual_Goal	Insignia	Invisalign	1.185	0.189	0.000
		SureSmile	0.953	0.187	0.000
Upper left first premolar MMR y_Actual_Goal	Insignia	Invisalign	0.875	0.146	0.000
		SureSmile	0.749	0.144	0.000
Upper left first premolar DMR y_Actual_Goal	Insignia	Invisalign	1.005	0.149	0.000
		SureSmile	0.891	0.147	0.000
Upper left second premolar B cusp y_Actual_Goal	Insignia	Invisalign	1.391	0.184	0.000
		SureSmile	1.243	0.185	0.000
Upper left second premolar MMR y_Actual_Goal	Insignia	Invisalign	1.320	0.150	0.000
		SureSmile	1.260	0.151	0.000
Upper left second premolar DMR y_Actual_Goal	Insignia	Invisalign	1.238	0.167	0.000
		SureSmile	1.232	0.168	0.000
Upper left first molar MB cusp y_Actual_Goal	Insignia	Invisalign	1.535	0.197	0.000
		SureSmile	1.418	0.198	0.000
Upper left first molar DB cusp y_Actual_Goal	Insignia	Invisalign	1.843	0.208	0.000
		SureSmile	1.804	0.209	0.000
Upper left first molar MMR y_Actual_Goal	Insignia	Invisalign	1.578	0.176	0.000
		SureSmile	1.442	0.177	0.000
Upper left first molar DMR y_Actual_Goal	Insignia	Invisalign	1.543	0.173	0.000
		SureSmile	1.526	0.174	0.000
Upper right lateral incisor CEJ actual_goal	Suresmile	Insignia	0.556	0.214	0.034
		Invisalign	0.831	0.189	0
Upper right central incisor CEJ actual_goal	Suresmile	Insignia	0.958	0.255	0.001
		Invisalign	0.746	0.226	0.005
Upper left central incisor CEJ actual_goal	Suresmile	Insignia	0.895	0.239	0.001
		Invisalign	0.804	0.212	0.001
Upper left lateral incisor CEJ actual_goal	Suresmile	Insignia	0.471	0.22	0.108
		Invisalign	0.645	0.195	0.005
Lower left first molar MB cusp x_Actual_Goal	Insignia	Invisalign	0.339	0.162	0.122
		SureSmile	0.570	0.164	0.003
Lower right second premolar B cusp x_Actual_Goal	Insignia	Invisalign	0.701	0.142	0.000
		SureSmile	0.469	0.143	0.005

Lower and upper arch gender distribution_

Treatment group	Female lower arches	Male lower arches	Total
Lower arches
Insignia (all from office 1)	6	11	17
Invisalign (11 from office 1, 17 from office 2)	22	6	28
SureSmile (all from office 2)	16	11	27
Total	44	28	72
Upper arches
Insignia (all from office 1)	6	12	18
Invisalign (11 from office 1, 17 from office 2)	22	6	28
SureSmile (all from office 2)	16	11	27
Total	44	29	73

Multivariable Linear Regression Analysis for (A) Alignment/Rotations Objective grading score, (B) Marginal ridge Objective grading score, (C) Buccolingual Inclination Objective Grading Score, and (D) Combined Intra-arch Objective Grading Score_

	Unstandardized Coefficients		Standardized Coefficients			95.0% Confidence Interval for B
Model	B	Std. error	Beta	t	p-value	Lower bound	Upper bound
(A) Alignment/Rotations Objective grading scorea
(Constant)	1.998	0.328		6.087	<0.001*	1.348	2.648
Invisalignb	1.291	0.326	0.444	3.963	<0.001*	0.646	1.936
Insigniab	0.57	0.289	0.185	1.97	0.051	-0.003	1.143
Female Gender	-0.06	0.249	-0.021	-0.24	0.811	-0.552	0.433
Age	0	0.013	-0.001	-0.01	0.992	-0.026	0.025
Crowding	0.007	0.073	0.008	0.098	0.922	-0.138	0.153
(B) Marginal ridge Objective grading score
(Constant)	0.461	0.229		2.013	0.046*	0.008	0.914
Invisalignb	-0.464	0.227	-0.239	-2.04	0.044*	-0.914	-0.014
Insigniab	0.257	0.202	0.125	1.271	0.206	-0.143	0.656
Female Gender	-0.186	0.173	-0.1	-1.07	0.287	-0.529	0.158
Age	0.014	0.009	0.18	1.58	0.117	-0.004	0.032
Crowding	0.031	0.051	0.054	0.606	0.546	-0.07	0.133
(C) Buccolingual Inclination Objective Grading Score
(Constant)	2.826	0.498		5.677	0.000*	1.84	3.811
Invisalignb	0.277	0.494	0.066	0.561	0.576	-0.701	1.255
Insigniab	-0.891	0.439	-0.201	-2.03	0.045*	-1.76	-0.022
Female Gender	0.177	0.377	0.044	0.47	0.639	-0.569	0.923
Age	-0.036	0.019	-0.213	-1.842	0.068	-0.074	0.003
Crowding	0.023	0.111	0.018	0.202	0.84	-0.198	0.243
(D) Combined Intra-arch Objective Grading Score
(Constant)	5.314	0.601		8.848	0	4.125	6.503
Invisalignb	1.121	0.593	0.226	1.889	0.061	-0.054	2.295
Insigniab	-0.047	0.527	-0.009	-0.089	0.93	-1.09	0.997
Female Gender	-0.05	0.452	-0.011	-0.111	0.912	-0.946	0.846
Age	-0.024	0.024	-0.118	-1.012	0.314	-0.07	0.023
Crowding	0.05	0.134	0.034	0.371	0.712	-0.215	0.315

List of dental landmarks used in the study on each type of tooth_

Tooth type	Landmark 1	Landmark 2	Landmark 3	Landmark 4
Right First Molar	Distobuccal Cusp Tip	Mesiobuccal Cusp Tip	Distal Marginal Ridge	Mesial Marginal Ridge
Right Second Premolar	Buccal Cusp Tip	Distal Marginal Ridge	Mesial Marginal Ridge
Right First Premolar	Buccal Cusp Tip	Distal Marginal Ridge	Mesial Marginal Ridge
Right Canine	Buccal Cusp Tip	Mesial-incisal Point	Distal-incisal Point
Right Lateral Incisor	Distal-incisal Point	Mesial-incisal Point	Labial CEJ
Right Central Incisor	Distal-incisal Point	Mesial-incisal Point	Labial CEJ
Left Central Incisor	Mesial-incisal Point	Distal-incisal Point	Labial CEJ
Left Lateral Incisor	Mesial-incisal Point	Distal-incisal Point	Labial CEJ
Left Canine	Buccal Cusp Tip	Mesial-incisal Point	Distal-incisal Point
Left First Premolar	Buccal Cusp Tip	Mesial Marginal Ridge	Distal Marginal Ridge
Left Second Premolar	Buccal Cusp Tip	Mesial Marginal Ridge	Distal Marginal Ridge
Left First Molar	Mesiobuccal Cusp Tip	Distobuccal Cusp Tip	Mesial Marginal Ridge	Distal Marginal Ridge

Mean and SD of observation period in months for each intervention_

System	Mean to observation period (months)	Observation period standard deviation (months)
Insignia	12.5	1
Invisalign	8.4	2.9
Suresmile	11.5	3.1