The Clear Chronicles - An Invisalign Treatment Blog

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ShiAnn

Chief Complaint:

Teeth becoming more crowded


Kelly

Chief Complaint:

Cannot bite front teeth together


Daniel

Chief Complaint:

Crowding of front teeth


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About Dr. Clark

Dr. Clark D. Colville is an assistant clinical professor in the Orthodontic department at the University of Texas Health Science Center Houston Dental Branch. Dr. Colville graduated from UTHSC San Antonio Dental School in 1989 and received a certificate from St. Francis Hospital and Medical Center the following year after completing a hospital-based general practice residency. In 1993 he completed his graduate orthodontic training at UTHSC Houston Dental Branch and received both a certificate and a Master's degree.


» Dr. Clark Colville’s Bio

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Shiann: Post treatment, Retention

ShiAnn

Chief Complaint:

Teeth becoming more crowded



As reported in the last treatment blog, ShiAnn was in a Hawley retainer with a bite plane and we were expecting the posterior occlusion to settle. ShiAnn returned in 6 weeks and the posterior teeth had settled adequately into functional occlusion. The gingival tissue responded well to the laser recontouring and I decided to add bonding to the mesial-incisal corner of both upper lateral incisors to make them look more natural (Figures 1, 2, 3, 4).

Kelly: End of Refinement

Kelly

Chief Complaint:

Cannot bite front teeth together



Kelly has completed all 15 of her refinement aligners and is currently awaiting delivery of her Vivera retainers. The following will outline her final treatment visits.

The aligners were delivered in series of 5, and were worn for 1 week each. At the delivery of the final 5 refinement aligners (11 – 15), the upper right lateral and cuspid were not completely tracking. Tight contacts were noted and reduced using a hand-held flexible strip. The remaining teeth in the arch were tracking well, including the lower arch (Figures 1, 2, 3).

Daniel: Retention

Daniel

Chief Complaint:

Crowding of front teeth



Daniel has been wearing his Vivera retainer full time since April 2009. Initially, the retainer was used to recapture the exact position of the teeth at the end of case refinement. After he had lost a Hawley retainer, the initial fit of the Vivera revealed there had been some shifting of the upper teeth because the retainer did not fully seat. After wearing the Vivera for 2 weeks, the teeth were fully seating in the retainer. I added dimples using the dimple plier to add retention in the posterior areas.

Justin: Refinement Completed

Justin

Chief Complaint:

Crowding of front teeth


The photos show Justin’s completed tooth movement. You will notice in the intraoral pictures with the aligners in place, on the right side, you can see through the aligner to the healing abutment of the implant in the #29 area. The aligners fit the teeth, and the space distribution for the implant restoration is equal to the M-D width of the first bicuspid #28.



Sheena: End of Treatment: Upper Aligner 14, Lower Aligner 13

Sheena

Chief Complaint:

Spaces between front teeth



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.


Stephanie: Aligner Delivery 16-18 & 19-20

Stephanie

Chief Complaint:

Teeth becoming more crowded



Aligner Delivery 16-18

Stephanie reports that she is doing well and is most compliant. As can be seen in the photos with the aligner in place, the aligners fit well with little on no space between the occlusal portion of the teeth and the internal occlusal portion of the aligner plastic. The contacts were checked, as is the case at each monitoring visit, and there were no tight contacts. In this case, no additional IPR was indicated.


Stephanie: Aligner Delivery 13 through 15

Stephanie

Chief Complaint:

Teeth becoming more crowded



It looks like Stephanie is progressing well. After checking the contacts with floss we discovered several areas with tight contacts. Using the “sequential/incremental” method to execute interproximal reduction (IPR), we elected to perform IPR at these tight contacts. The tight contacts were at contacts 22-23, 23-24, 24-25, 25-26, 26-27. The IPR prescription approximation called for a total of 0.3mm IPR at each of these contacts.


Sheena: Aligner Delivery 13 through 14

Sheena

Chief Complaint:

Spaces between front teeth



Sheena was unable to return to the office for a scheduled monitoring visit at aligner 10 but did continue consistent aligner wear and presented having completed wear of aligner #12. Sheena continues to track well, and is only a few aligners away from the original predicted finish. She did not report any problems and is anxious to finish her treatment.


Justin: Final Aligner Delivery & Attachment Removal

Justin

Chief Complaint:

Crowding of front teeth


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.


ShiAnn: Aligners Completed: 35 upper and lower

ShiAnn

Chief Complaint:

Teeth becoming more crowded



ShiAnn’s treatment was completed after all 35 upper and lower aligners were worn for the prescribed period. Case refinement was expected as the final phase of treatment. However, close evaluation at the completion of aligner 35 revealed that case refinement was not necessary.