Tuesday, December 13, 2011
Chief Concern and History: 27-year-old male patient with a chief concern of “space in my front grill” with “chipping.” Patient had several consults and was told Invisalign will not be able to help his case.
Treatment Options: 1. Do nothing - possibly risk losing the patient.
2. Refer to an Orthodontist and Oral Surgeon - possible surgery and the correction of Class III bite.
3. Restorative solution- “Instant orthodontics” - #7-10 or #8-#9 resulting in enamel damage and the overjet has not been addressed. The result is a risk of future fracture of the restorations.
4. Invisalign Option - Need for Interproximal Reduction (IPR) on lower anteriors and closing of upper incisors within 9-12 month treatment time. (Note the possible midline discrepancy between upper and lowers.) The other issue to be aware of is the management of upper interpapillary tissue between central incisors.
Treatment Course Description: 15 Upper Aligners and 19 Lower Aligners. The initial treatment sequence was designed to lingualize lower anteriors with two exceptions. The lower anterior IPR will be .3 mm from the mesial surfaces of #22 to #27. Since the patient has distal spacing on lower canines. we can use this to our advantage in avoiding any change in posterior occlusion on the patient or risk of TMD. The intra-arch space needed between upper and lower anteriors now can be addressed by making room in starting the lingulization phase of lower teeth. The uppers teeth would follow with a programmed lag. As the upper diastema between teeth #8 and #9 are closing, the interpapillary tissue will have to be addressed. Note: the frenectomy can be planned prior to starting aligner treatment by viewing the ClinCheck software. Closure of the diastema and tissue impingement can also be noted on aligners 11. Considering we can look at the patient's full treatment plan, we can determine when is the best time to remove the frenulem between upper central incisors. The allows us to have better case management and most importantly patient comfort. The tissue was removed via Biolase diode carbon at aligner #11. The final result of 1 mm overjet and overbite of incisal arches was achieved by adding a refinement with C-Chain and tightening all contacts .
Final Result: Anterior coupling is now within normal limits of 1mm overjet/overbite. There was a slight anterior midline discrepancy of .5 mm. The patient was extremely happy with result. Six-month follow-up shows a controlled closed diastema and great patient compliance with the Vivera retainer program from Align.
