Justin has completed aligner wear and presents having finished wearing upper aligner #11 and lower aligner #10. As you can see in the photos, the arch shape looks good but there are several anterior rotations and some arch form symmetry to complete. At this point the results are good but need some additional movements for a “stellar” finish. The solution is to use a refinement that is included with the Invisalign Full product. The refinement provides for a new ClinCheck that we may modify to create a new series of aligners to achieve the desired results.
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First I removed the attachments prior to taking new PVS impressions. Attachment removal allows you to send Align a most accurate reproduction of the morphology of the teeth. This provides the accurate information for the CT scan and digital conversion and allows the full options for attachment placement.
PVS upper and lower impressions were sent as well as a new PVS centric bite taken in maximum intercuspation.
A standard intraoral photo series was taken consisting of teeth together anterior view, right buccal , left buccal view and upper and lower occlusal views (see “RefinementTemplate” image). The photos need to be only intraoral photos, as extraoral photos are not required. It is most helpful to use Align’s photo template to organize the photos and maintain the full pixel value of the photos.
Finally, a simple refinement on-line prescription form was completed. One thing you will need to provide on the form is the total number of aligners for each arch and the completed aligner stage. There is a “box” to add specific refinement requests. The form is accessed with the “case forms” tab on your VIP page.
You may want to take a look at the separate pictures and discussion of attachment removal included in this blog.
Justin will continue full time 4/7 wear of the last aligners upper #11 and lower #10 until the new refinement aligners are delivered. Generally, it takes about a month from refinement submission to delivery. We will see Justin at that time.
Attachment Removal
It may help to review several attachment removal techniques. The primary objective is to completely remove the composite resin form without damage to the surface of the tooth it was bonded to and minimize potential soft or hard tissue damage.
The most common technique for removal is to use a highspeed handpiece with a multifluted carbide finishing bur. Using light sweeping strokes, the composite material can easily be removed (See Finishing Bur). After the composite material is removed you will want to polish the surface. I use the Sof-lex discs (See Sof-Lex disc) commonly used to polish composite material. Most similar materials will also work. It may help to use magnification loops to help avoid “scoring” the tooth surface. It will also help use the high speed without water to help see the differentiation between tooth and composite material (See dry cutting). Typically, I cut with water for the gross removal and little or no water at the very end to identify composite from tooth structure.
A second attachment removal method is to use a “bracket removal plier” commonly used in orthodontics. The plier tips have a sharp edge that can be used to engage the attachment (See bracket removal pliers). This technique works best with the most prominent attachments such as rectangular/CRT or beveled attachments. The ellipsoid attachments are difficult to engage due to the rounded shape. A slight cut into the composite for either proximal side will help the plier engage the composite to facilate removal. Once again after composite removal, magnification and dry air can help identify any remaining composite material.
A third method is a hand scaler. This may help with small composite remnants but I have found it slow and inefficient for gross removal. The scaler may help to remove small amounts left after using the “bracket remover plier”.
