May 1, 2009 - 8:19am
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.
The decision to NOT do case refinement was based on the two major findings at the end of treatment. First, the final panoramic x-ray (Figure 11) showed that root alignment was good, not perfect, but very good. The final panoramic x-ray also showed that the amount of root resorption throughout the entire dentition was significant enough that further treatment, unless absolutely necessary, should be avoided.
The second major factor was the evaluation of the occlusion. I expected that the lower incisors would be contacting heavily with the lower anterior teeth. This would have required further treatment to intrude the lower incisors, with IPR likely needed. The final occlusion showed only light contact on the upper central incisors. I was able to do an occlusal adjustment to remove the light contacts completely. This treatment goal was very important because of the significant root resorption on the upper central incisors.
The occlusion in the anterior was now contacting on the cuspids that have been moved into the lateral position. This is what I wanted, and now we could move forward. The next occlusal priority is to close the transient posterior open bite. This is something we do routinely with Invisalign patients.
From this point, the plan is straight-forward. Bond a lower lingual retainer from cuspid to cuspid, make a wrap-around Hawley retainer with a bite plane in the anterior, and then allow the posterior teeth to passively erupt into final occlusion. This protects the upper central incisors from further movement to hopefully limit further root resorption.
At this appointment, the attachments were removed (Figures 1, 2, 3); a soft-tissue laser was used to recontour the gingiva on the facial and lingual of the upper anterior teeth (Figures 4, 5.) An impression was made for the fabrication of the Hawley retainer and ShiAnn was asked to continue wearing aligner 35 until the Hawley was ready to deliver.
ShiAnn returned one week later and the Hawley retainer (Figures 7, 8, 9) was delivered, and the occlusion was rechecked to make sure we avoided traumatic occlusion on the upper central incisors (Figures 10, 12, 13, 14, 15). The upper cuspids were reshaped to make them appear more like lateral incisors. The posterior teeth appear to be settling well, even after only one week.
ShiAnn is scheduled to return for a retainer check visit 8 weeks following delivery of the upper retainer. My plan is to do a final occlusal adjustment and make a PVS impression to fabricate a series of Vivera retainers.
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.
The decision to NOT do case refinement was based on the two major findings at the end of treatment. First, the final panoramic x-ray (Figure 11) showed that root alignment was good, not perfect, but very good. The final panoramic x-ray also showed that the amount of root resorption throughout the entire dentition was significant enough that further treatment, unless absolutely necessary, should be avoided.
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The occlusion in the anterior was now contacting on the cuspids that have been moved into the lateral position. This is what I wanted, and now we could move forward. The next occlusal priority is to close the transient posterior open bite. This is something we do routinely with Invisalign patients.
From this point, the plan is straight-forward. Bond a lower lingual retainer from cuspid to cuspid, make a wrap-around Hawley retainer with a bite plane in the anterior, and then allow the posterior teeth to passively erupt into final occlusion. This protects the upper central incisors from further movement to hopefully limit further root resorption.
At this appointment, the attachments were removed (Figures 1, 2, 3); a soft-tissue laser was used to recontour the gingiva on the facial and lingual of the upper anterior teeth (Figures 4, 5.) An impression was made for the fabrication of the Hawley retainer and ShiAnn was asked to continue wearing aligner 35 until the Hawley was ready to deliver.
ShiAnn returned one week later and the Hawley retainer (Figures 7, 8, 9) was delivered, and the occlusion was rechecked to make sure we avoided traumatic occlusion on the upper central incisors (Figures 10, 12, 13, 14, 15). The upper cuspids were reshaped to make them appear more like lateral incisors. The posterior teeth appear to be settling well, even after only one week.
ShiAnn is scheduled to return for a retainer check visit 8 weeks following delivery of the upper retainer. My plan is to do a final occlusal adjustment and make a PVS impression to fabricate a series of Vivera retainers.
