Tuesday, December 13, 2011
Chief Concern and History: 20 year old male patient with chief concern of diastema of approximately 4-5 mm between upper central incisors. Patient also in the military and only has less than a year to address chief concern before his deployment.
1. Do nothing - possibly risk losing the patient.
2. Refer Orthodontist - possible longer treatment time and possible bicuspid extractions.
3. Restorative solution - “Instant orthodontics” - Enamel damage from prepping the teeth would still result in large central veneers and a possible need for more than 2 anterior restorations on upper laterals (due to uneven smile line and laterals #7 and #10 length).
4. Invisalign Option - Need for minor Interproximal Reduction (IPR) on lower anteriors and closure of upper incisors within 9-12 month treatment time.
Treatment Course Description: 15 Upper Aligners and 9 Lower Aligners, with one refinement of 6 Aligners on both the upper and lower arch to tighten all contacts, called ‘C-Chain.’ Initial treatment sequence was designed to lingualize lower anteriors by adding .2 mm interproximal reduction to all lower anteriors from distal of #22 to distal #27. This will address the intra-arch space needed between (upper and lower) anterior arches. For the lingualization phase of upper teeth, the goal is to close the diastema finishing in 1 mm overjet and overbite of incisal arches. Note: Patient compliance is of outmost importance during the course of treatment especially once the lower IPR has been initiated. Once the inter-proximal contacts have been removed from the lower anteriors, the guidance and tension of aligners are needed for a minimum of 21 hours a day. Based on my clinical data and experience, for every 4 hours of non-compliance (not wearing the aligners), the teeth have reverted and relapsed the equivalent of 72 hours of normal wear.
Final Result: A 6 month follow-up shows a closed diastima and locked in anterior bite. Anterior coupling is within normal limits of 1 mm overjet/overbite. The uneven tooth discrepancy in the length of the lateral incisors was also addressed by relative extrusion without the use of any composite attachments. X-rays show no sign of root resorption or interaridicular abnormality Note: As teeth start to lingualize, they appear to get longer due to the change in the root angulation. They are no longer in an overjet buccal position but instead has been torqued lingual adding an extrusive effect. Again, there is no need for the placement of composite attachments so long as the aligners are engaging. The patient was happy and was called to leave early for the military. We then put him in a Vivera retainer program that could auto-ship a fresh set of retainers to him every 3 months.