Sheena returned for her monitoring visit having completed wear of upper aligner 14 and lower aligner 13. These were the last stages of the original case. The photos show the intraoral standard views with and without the aligners. The space has closed but there remains some “openbite” in the bicuspid areas. This is likely the result of the “relative” intrusion effect of the retraction of the teeth to close the spaces. A refinement will be done to give some additional aligners to help improve the posterior occlusion.
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Creation of an “open” posterior bite is not unusual in space closure cases with anterior segment retraction. As the controlled crown movement forces tip the anterior teeth the anterior teeth appear to extrude and the curve of Spee in the bicuspid area may then become more exaggerated leaving an “openbite” tendency. Some posterior leveling and anterior intrusion will be employed to hopefully improve the occlusion.
For the refinement phase all attachments are removed. Upper and lower PVS impressions and a PVS centric bite are sent to Align. The electronic refinement submission included the prescription form and intraoral photo template. Extraoral photos are not necessary for refinement. It is recommended that the attachments are removed prior to taking the PVS impressions.
Sheena’s next appointment will be to place her refinement attachments and deliver her aligners.
