May 1, 2009 - 8:17am
Treatment date: 4-10-09
Kelly started case refinement aligners in late March. CR aligners numbered 1 thru 6 were delivered after attachments were bonded. Scheduled IPR was performed on the lower arch (Figures 1, 2, 3). That is the short and simple explanation of what has happened since January when impressions were sent to initiate case refinement.
The stories behind the scene were all the difficult decisions that were made in modifying the ClinCheck. The projected solutions discussed in the January 2009 treatment blog identified the problems accurately. Getting to the final ClinCheck required a series of compromises. I will outline some of these.
First, any further sagittal correction was going to come from IPR in the lower arch. Further elastic wear is not scheduled due to the minor correction that was seen when Kelly wore the elastics very well in the first series of aligners. As a result, the maximum IPR was done in almost every available location in the lower anterior teeth, starting at the distal of each cuspid. A total of 2.3 mm of IPR will be done in an effort to develop overjet and overbite.
The next hurdle was attachment design and placement. With arch leveling being the main concern in the initial set of aligners, I place emphasis on root alignment in case refinement. Vertical CRT attachments are placed on all teeth that need root tip correction. Thus, 5 teeth in the lower arch, and one tooth in the upper arch will have these attachments. In the lower arch, tooth 30 still needs to upright, so horizontal bevel attachments are going on the buccal and lingual surfaces to try to achieve this correction. The real dilemma was the number of attachments in the upper arch. Almost every tooth is extruding in an attempt to develop some occlusion. The final result is that nine teeth in the upper arch are having 1 mm ellipsoid attachments, or 321 horizontal bevel attachments. I rarely consider placing this number of attachments, but felt I had no choice. It is just a tough situation. The upper right lateral and cuspid are the rate determining teeth, with close to 2 mm of extrusion relative to the adjacent teeth. As a result, there are a total of 15 refinement aligners. Figures 4, 5, 6 show aligner 0 of the refinement ClinCheck. Figures 7, 8, 9 show aligners 15 of the refinement ClinCheck.
As is usual for me, I have my patients wear case refinement aligners for 1 week at a time. I encouraged Kelly to keep a close watch to make sure all teeth were fully engaged in the aligners before moving on to the next aligners.
Kelly
Chief Complaint:
Cannot bite front teeth together
Kelly started case refinement aligners in late March. CR aligners numbered 1 thru 6 were delivered after attachments were bonded. Scheduled IPR was performed on the lower arch (Figures 1, 2, 3). That is the short and simple explanation of what has happened since January when impressions were sent to initiate case refinement.
The stories behind the scene were all the difficult decisions that were made in modifying the ClinCheck. The projected solutions discussed in the January 2009 treatment blog identified the problems accurately. Getting to the final ClinCheck required a series of compromises. I will outline some of these.
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The next hurdle was attachment design and placement. With arch leveling being the main concern in the initial set of aligners, I place emphasis on root alignment in case refinement. Vertical CRT attachments are placed on all teeth that need root tip correction. Thus, 5 teeth in the lower arch, and one tooth in the upper arch will have these attachments. In the lower arch, tooth 30 still needs to upright, so horizontal bevel attachments are going on the buccal and lingual surfaces to try to achieve this correction. The real dilemma was the number of attachments in the upper arch. Almost every tooth is extruding in an attempt to develop some occlusion. The final result is that nine teeth in the upper arch are having 1 mm ellipsoid attachments, or 321 horizontal bevel attachments. I rarely consider placing this number of attachments, but felt I had no choice. It is just a tough situation. The upper right lateral and cuspid are the rate determining teeth, with close to 2 mm of extrusion relative to the adjacent teeth. As a result, there are a total of 15 refinement aligners. Figures 4, 5, 6 show aligner 0 of the refinement ClinCheck. Figures 7, 8, 9 show aligners 15 of the refinement ClinCheck.
As is usual for me, I have my patients wear case refinement aligners for 1 week at a time. I encouraged Kelly to keep a close watch to make sure all teeth were fully engaged in the aligners before moving on to the next aligners.
