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Invisalign presentation
1. Case Presentation of a
typical orthodontic case of
moderate difficulty using
the Invisalign method
Name: A S, DMD IV, 2012
Date: March, 2012
2. Occlusion
Right Side Dental Midline Left Side
Molar Class: I Upper: On Molar Class: N/A
Canine Class: I Lower: On Canine Class: I
Pre-Treatment
3. Intra-Oral Examination
Teeth Present:
11-17, 21-25, 27
31-35, 37, 41-47
Arch Shape:
Upper: Normal to tapered
Lower: Normal to tapered
Pre-Treatment
4. 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
5. Intra-Oral Examination
Amount of Crowding:
Upper Arch: Mild ~ 3 mm
Lower Arch: Mild ~ 3mm
Pre-Treatment
6. Panoramic Radiograph Analysis
Clinical Findings:
No suspected decay or bone pathology
Permanent dentition: 26 teeth present (Missing 8’s, 26 & 36)
Pre-Treatment
8. Dental Cast Analysis
Bolton Analysis – Ideally 77%
Tooth Upper right Upper left Ideal
Central Incisor 8.5 8.0 8.85
Lateral Incisor 5.5 6.0 6.9
Canine 6.7 7.0 7.88
Tooth Lower right Lower left Ideal
Central incisor 5.1 5.0 5.5
Lateral incisor 5.3 5.4 6
Canine 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
9. 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
10. Diagnosis
Class I molar/canine
Maxillary anterior crowding
Mandibular anterior crowding
50% overbite
Flat to slight curve of spee
Pre-Treatment
11. 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
13. Occlusion
Right 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
14. Intra-Oral Examination
Teeth Present:
11-17, 21-25, 27
31-35, 37, 41-47
Arch Shape:
Upper: Normal to tapered
Lower: Normal to tapered
Crowding:
Upper: Normal
Lower: Normal
Post-Invisalign Treatment
16. 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
23. Dental Cast Analysis
Bolton Analysis – Ideally 77%
Tooth Upper right Upper left Ideal
Central Incisor 8.3 8.1 8.85
Lateral Incisor 5.8 5.8 6.9
Canine 7.3 7.1 7.88
Tooth Lower right Lower left Ideal
Central incisor 5.2 4.7 5.5
Lateral incisor 5.1 5.3 6
Canine 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
24. 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
25. 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.