Treatment date: 10-20-2008

Daniel returned today and was excited to have completed the initial series of aligners. At this point all the attachments were removed, the teeth were shaped to optimize the esthetic appearance, and the occlusion was checked closely to determine what needs to be accomplished in case refinement. Refinement PVS impressions were made along with photos and a panoramic x-ray.

Esthetic shaping is an important component of the finishing process and we always do this following the initial series of aligners. Daniel’s central incisors had a lot of uneven incisal edges which required significant reshaping. However, we did not completely remove all the uneven edges. Following the refinement aligners we will bond the small chips on the incisal edges and then do the final reshaping. The lower incisors required reshaping on the incisal edges also. It became obvious the size and shape of the upper central incisors are not similar. Daniel said he also had noticed this. This will be addressed in case refinement where I will likely reduce the size of tooth 9.

The occlusion is very good at this point, in fact almost too good. There were occlusal contacts on all anterior and posterior teeth. I noticed that tooth 10 did not rotate completely into position and the likely reason was the occlusion. The occlusal contact on both lingual marginal ridges of tooth 10 prevented any further rotation. In addition to the incisal edge reshaping done today, this will need to be addressed in case refinement where space will be made by further intrusion of the upper and lower anterior teeth. This intrusion will create the space required to correct the rotation and allow arch length reduction that will occur when the mesio-distal width of tooth 9 is reduced. The tight anterior contacts probably prevented further sagittal correction on the right side where Daniel was wearing elastics. The following teeth will require rotation correction in case refinement: 8, 10, 24, and 27.

All interproximal contacts were checked and the only open contact was between the upper central incisors. This is quite interesting because we did a significant amount of IPR that was not scheduled. There was no IPR required according to the ClinCheck that was accepted. However, when we sum all the IPR that was performed there were multiple interproximal contacts with an excess of 0.20 mm of IPR throughout treatment, and no IPR was done between the upper central incisors. I had a similar situation in the lower arch. Multiple interproximal areas had more than 0.15 mm of tooth reduction, and yet there are no open contacts at the end of this series of aligners.

To summarize, case refinement will be done to detail and finish Daniel’s treatment. I expect 5-8 additional aligners and 2 additional visits. Daniel will wear essix type retainers for 12 hours per day to maintain his current tooth position. These were fabricated from models that were poured from the refinement impressions that were made today. We expect to deliver refinement aligners in 8 weeks.