Tuesday, December 13, 2011
Chief Concern and History: 24-year-old female patient found us on the Invisalign doctor site, with a concern “I bite my lip all the time and don’t want wires.” The patient has her own dentist, but was told she was not an Invisalign candidate. Our exam showed lower crowding greater than 6 mm with rotation of lower cuspids greater than 30 degrees. She had a deep anterior bite greater than 4 mm with overlapping lateral incisors, and a need for midline correction greater than 2 mm. Class I occlusion - narrow upper and lower arches with heavy wear with multiple dentistry.
Treatment Options: 1. Do nothing – Patient to seek another clinician.
2. Refer back to Ortho – Patient did not want wire and brackets.
3. Enameloplasty – Shaving the upper central incisors which is limited as well as questionable care with poor prognosis.
4. Invisalign Option - Need for Interproximal Reduction (IPR) on lower anteriors with proclination and expansion on both upper and lower archs. Note: Expansion can be achieved by first uprighting premolars and molars, followed by proclination on both upper and lower anteriors with IPR to follow.
Treatment Course Description: 9 Initial upper aligners / 18 lower aligners. The initial aligners used for “rounding-out” the upper arch with intrusion of 2 mm added correcting the deep bite on teeth #8 and #9. Note: additional upper aligners were ordered at no additional fee called ‘passive aligners’ which has no pressure built into the aligners which help in facilitate the finish on both arches. Lower arch expansion was done by uprighting molar and premolar of 20 degrees (aprox 2 mm). Next, we planned on proclination on all lower anteriors and IPR of .2 mm on teeth #22 to #27. Rotating the lower canine’s was now an easier task since the lower arch form is slightly proclined only needing half of the cuspid rotations. A refinment set of 5 secondary set of aligners then were used to ensure tight contacts and proper occlusion viewed on the Align’s ClinCheck software program.
Final Result: She had improved upper and lower anterior arch coupling, with reduction of the deep bite. We improved the lower cuspid rotations with enhanced arch form, gaining lower buccal cusp to upper central fosse occlusion. This would then aid in the reduction of malocclusion and unacceptable wear on lower / upper teeth. We then put the patient on a retainer regimen and sent her back to her prior dentist.
