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Invisalign presentation Invisalign presentation Presentation Transcript

  • Case Presentation of atypical orthodontic case of moderate difficulty using the Invisalign methodName: A S, DMD IV, 2012Date: March, 2012
  • OcclusionRight Side Dental Midline Left Side Molar Class: I  Upper: On  Molar Class: N/A Canine Class: I  Lower: On  Canine Class: I Pre-Treatment
  • Intra-Oral Examination Teeth Present:11-17, 21-25, 2731-35, 37, 41-47 Arch Shape:Upper: Normal to taperedLower: Normal to tapered Pre-Treatment
  • Intra-Oral Examination Clinical Findings:  Molars: Class I on right; Missing 26 & 36 on left  Canines: Class I  Missing: 18, 26, 28, 36, 38 & 48  OJ: 2 mm on right; 3 mm on left  OB: 50%  Mild crowding on both upper & lower incisors Pre-Treatment
  • Intra-Oral Examination Amount of Crowding:Upper Arch: Mild ~ 3 mmLower Arch: Mild ~ 3mm Pre-Treatment
  • Panoramic Radiograph Analysis Clinical Findings: No suspected decay or bone pathology Permanent dentition: 26 teeth present (Missing 8’s, 26 & 36) Pre-Treatment
  • Cephalometric Analysis Angles Ceph. Normal Values Skeletal Measurements SNA 79.5 81 ± 3 SNB 75.0 78 ± 3 ANB 4.5 3±2 Witts -4.0 2 mm ± 2mm Facial 86.0 88 ± 4 MPAST 38.0 32 ± 3 Y axis 60.0 60 ± 4 Dental Measurements (UI,NA) 16.0 23 ±6 (LI,NB) 23.0 27.5 ±5 (UI,LI) 135.0 130 ± 7 (LI,MP) 91.0 91.4 ± 4 Pre-Treatment
  • Dental Cast Analysis Bolton Analysis – Ideally 77%Tooth Upper right Upper left IdealCentral Incisor 8.5 8.0 8.85Lateral Incisor 5.5 6.0 6.9Canine 6.7 7.0 7.88Tooth Lower right Lower left IdealCentral incisor 5.1 5.0 5.5Lateral incisor 5.3 5.4 6Canine 5.4 5.2 6.95 • UA (Σ 13-23) = 41.7 mm • LA (Σ 33-43) = 31.4 mm • ( 31.4 / 41.7 ) x 100 = 75.3% Pre-Treatment
  • Summary of Findings Dental:  Molars: Class I on right; Missing 26 & 36 on left  Canines: Class I  Missing: 18, 26, 28, 36, 38 & 48  OJ: 2 mm on right; 3 mm on left  Increased OB (50%)  Lower dental midline deviates 2 mm to the left upon opening  Mild crowding on both upper & lower incisors  Normal to tapered arch shapes  6 mm of upper incisors showing at rest Bolton analysis: 75.3% Skeletal:  Symmetrical face; Normocephalic  Decreased lower face height  Slight-moderate convex profile Pre-Treatment
  • Diagnosis Class I molar/canine Maxillary anterior crowding Mandibular anterior crowding 50% overbite Flat to slight curve of spee Pre-Treatment
  • Objectives of Treatment Resolve patient’s chief complaint of crowding Decrease overbite Maintain class I molar/canine relationship Maintain nasolabial angle Maintain midlines Pre-Treatment
  • Exactly One Year Later Post-Invisalign Treatment
  • OcclusionRight Side Dental Midline Left Side Molar Class: I  Upper: On  Molar Class: N/A Canine Class: I  Lower: On  Canine Class: I Post-Invisalign Treatment
  • Intra-Oral Examination Teeth Present:11-17, 21-25, 2731-35, 37, 41-47 Arch Shape:Upper: Normal to taperedLower: Normal to tapered Crowding:Upper: NormalLower: Normal Post-Invisalign Treatment
  • Post-Invisalign Treatment ProblemsPatient not satisfied with the final position of tooth #32 & tooth #41 Post-Invisalign Treatment
  • Post-Invisalign Treatment Solution Dimple-maker! Dimples added to:  Tooth #32 - distal buccal incisal area  Tooth #41 - distal buccal incisal area IPR on both tooth #32 & #41 Both teeth rotated into proper position within 2 weeks Dimples then added to:  Tooth #31 - distal buccal incisal area & mesial lingual incisal area Patient now satisfied with final results Post-Invisalign Treatment
  • Post-Invisalign Treatment Solution Pre-Treatment Post-Invisalign Treatment Post-Treatment
  • Post-Treatment
  • Intra-Oral ExaminationPre-Treatment Post-Treatment Decrease in both overbite & overjet
  • Intra-Oral Examination No change from pre-treatment:  Arch Shape: Upper: Normal to tapered Lower: Normal to taperedPre-Treatment Post-Treatment
  • Panoramic Radiograph Analysis Clinical Findings: No suspected decay or bone pathology Permanent dentition: 26 teeth present (Missing 8’s, 26 & 36) Post-Treatment
  • Cephalometric Analysis Angles Ceph. Normal Values Skeletal Measurements SNA 80.0 81 ± 3 SNB 75.0 78 ± 3 ANB 5.0 3±2 Witts -4.5 2 mm ± 2mm Facial 84.0 88 ± 4 MPAST 39.5 32 ± 3 Y axis 63.0 60 ± 4 Dental Measurements (UI,NA) 12.0 23 ±6 (LI,NB) 22.5 27.5 ±5 (UI,LI) 141.0 130 ± 7 (LI,MP) 87.5 91.4 ± 4 Post-Treatment
  • Dental Cast Analysis Bolton Analysis – Ideally 77%Tooth Upper right Upper left IdealCentral Incisor 8.3 8.1 8.85Lateral Incisor 5.8 5.8 6.9Canine 7.3 7.1 7.88Tooth Lower right Lower left IdealCentral incisor 5.2 4.7 5.5Lateral incisor 5.1 5.3 6Canine 6.1 5.8 6.95 • UA (Σ 13-23) = 42.4 mm • LA (Σ 33-43) = 32.2 mm • ( 32.2 / 42.4 ) x 100 = 75.9% Post-Treatment
  • Summary Dental:  Molars: Class I on right; Missing 26 & 36 on left  Canines: Class I  No atempts made to resolve the skeletal discrepancy  OJ: 2 mm on right; 1 mm on left  OB (30%) - Decreased from 50% at pre-treatment  Lower dental midline deviates 2 mm to the left upon opening  Crowding issues on both upper & lower incisors resolved (addressed CC)  Normal to tapered arch shapes 6 mm of upper incisors showing at rest Skeletal:  Symmetrical face; Normocephalic with dolichocephalic tendenty remained  Slight-moderate convex profile remained Post-Treatment
  • Conclusions• Overall, patient is very satisfied as her chief complaint has been addressed.• Opted for Invisalign type retainers.• IPR avoided any flaring of the dentition• The upper incisors were not torqued enough but the esthetic result is still very acceptable.