Daniel completed all 8 refinement aligners and then moved on to the overcorrection aligners in both arches (Figures 4, 9). Tooth 8 and tooth 27 needed additional rotation correction. Both teeth had 4 degrees of overcorrection planned. The contacts were checked closely to make sure space was available. As an added measure, I added dimples to enhance the rotational moments of force on these two teeth.

Daniel returned 3 weeks later and the lower arch was completed, but the upper right central still needed some rotation correction (Figures 1, 2, 3, 7). In the lower arch, attachments were removed and the lingual retainer was bonded (Figure 6). The occlusion was good and I had to decide how to correct the rotation on tooth 8. I have rarely used a second case refinement, and in this instance, additional aligners for 1 tooth did not seem to be the best choice. I opted to make a wrap-around Hawley with a finger spring to make the final rotation correction (Figure 10). I thought this was a good choice because it allowed for settling of the posterior teeth into final occlusion, and I would be able to make adjustments as needed, until the central was well aligned.

Some plans work well, and some don’t. This one didn’t because Daniel lost his retainer. On top of that, I could tell some of the other anterior teeth didn’t look as good as when we delivered the Hawley retainer. The changes were subtle, but I just didn’t like what I was seeing. It was time to make another decision. At this point I elected to go to a Vivera retainer in the upper arch. We made an in-house essix to hold his current alignment, and ordered Vivera retainers to fit the position at case refinement aligner 8, before overcorrection started. I thought the aligner would be a tough fit at CR8, and that he may not be able to get an overcorrection position to fit over the teeth. The Vivera retainer was delivered in the first week of April, and it was a very tight fit that did not seat fully into place (Figures 5, 8). I expect with full time wear, the retainer will fit more snugly. I will deliver the next Vivera retainer in 6 weeks, as I expect some deformation of the plastic to occur initially as we try to get the final alignment of tooth 8.