Treatment date: 10-23-2008

We are getting near the end of the initial set of aligners and things are progressing nicely for ShiAnn. She learned to get the upper aligners in and out easily and noted that the aligners were much more retentive without the pontic teeth present. The upper central incisors are completely engaged in the aligners and the lag that was previously noted is not present. The spaces are almost closed! There is no contact between the upper and lower incisors at this point. I delivered the next 3 sets of aligners, rather than the usual 4. The reason is to closely watch the overjet and overbite to avoid traumatic occlusion on the central incisors. Two factors cause concern when evaluating ShiAnn’s potential for traumatic occlusion in the anterior teeth. First, the lower arch leveling is likely to be somewhat less than shown in the ClinCheck. In addition to that, the transient posterior intrusion that comes from full time aligner wear decreases the total amount of arch leveling which increases the overbite and provides autorotation of the mandible. Given those 2 factors, I may opt to send for refinement aligners prior to completion of the first set of 35 aligners.

Generalized gingivitis was noted in both arches. Hygiene instructions were reviewed with ShiAnn. Regarding Invisalign patients in general, this is about the extent of hygiene problems that appear from time to time. The incisive papilla on the lingual of the upper central incisors appears inflamed, as well as the tissue where the spaces are being closed. Prior to case refinement, we will recontour the gingiva as needed; and we will also reshape the cuspids to appear more like lateral incisors.

ShiAnn will be evaluated in 6 weeks to determine the next step.