I’d like to share a case involving a very typical situation that most GPs will see in their practices. It includes resolution of adult onset crowding (seen in more than 70% of adults) as well as managing implant space for implant restoration.
Justin is a 25-year-old, senior dental student. He attended the Invisalign training I presented to his class as part of their orthodontic curriculum. The Invisalign course piqued Justin’s interest to consider straightening his “crowded” front teeth.
As it turned out, not only did Justin have teeth to straighten, but he also exhibited a missing permanent bicuspid tooth and a “well-worn” retained deciduous tooth. He felt that Invisalign offered an esthetic alternative to traditional “braces” and an opportunity to treat both his malocclusion and missing permanent tooth at the same time.
Justin provides a great opportunity to observe everyday restorative solutions with implants as well as to follow the basic orthodontic movements and resolution of a mildly crowded Invisalign case. His chief complaint: Straighten the crowded front teeth and fix the missing bicuspid tooth with an implant.
Initial Treatment Plan:
- Resolve upper and lower crowding
- Resolve canine rotations
- Maxillary expansion and procline with no IPR
- Mandibular expansion and procline
- Resolve mandibular right canine crossbite
- Reduce space of “T” for space management and to aid implant restoration
- Maintain Class I A-P relationships
The case began with Align’s Clin Check review process in early June. After adjustments to the treatment plan were finalized, the first set of aligners was delivered on mid-July. In mid-September, while the aligners were being worn, the restorative portion of the treatment was started—extraction and implant placement.
Close monitoring is done throughout the process; reasonable compliance is very important and each monitoring visit is an opportunity to evaluate compliance and once again motivate the patient. Success depends on proper compliance. Often patients may report compliance but really mean something different that what is required.
Treatment was completed the following August, for a total procedure time of about 14 months.