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Invisalign Study Club Meeting 1 - Treatment Planning


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Invisalign Study Club Meeting 1 - Treatment Planning

  1. 1. Invisalign Study Club: Session 1 Treatment Planning March 20, 2008 Brian H. Bergh, DDS, MS 1111 N Brand Blvd, Ste 201 Glendale, CA 91202 (818) 242-1173
  2. 2. Doctor Background <ul><li>Loma Linda University Dental School </li></ul><ul><li>USC Dental School, Certificate in Orthodontics </li></ul><ul><li>USC Graduate School, MS Craniofacial Biology </li></ul><ul><li>Invisalign Premier Provider </li></ul><ul><li>Over 260 cases submitted </li></ul><ul><li>Email: [email_address] </li></ul><ul><li>Phone #: 818-242-1173 </li></ul>
  3. 3. Setting Treatment Goals <ul><li>An ideal outcome starts with with a good treatment plan. </li></ul><ul><li>Keys to Treatment Planning with Invisalign. </li></ul>ClinCheck Quality Treatment Outcomes Treatment Planning Finishing
  4. 4. Keys To Treatment Planning <ul><li>Understand the appliance and difficult movements: </li></ul><ul><ul><li>Absolute extrusions </li></ul></ul><ul><ul><li>Severe rotations of round teeth </li></ul></ul><ul><ul><li>Large – span translations/extractions </li></ul></ul><ul><li>Recognize and incorporate solutions into the treatment plan </li></ul><ul><ul><li>Auxiliary Treatment </li></ul></ul><ul><ul><ul><li>IPR, Detail Pliers, Button Kit, Attachments, Elastics </li></ul></ul></ul><ul><ul><ul><li>Strategic staging in ClinCheck </li></ul></ul></ul><ul><ul><ul><li>Build in case refinement </li></ul></ul></ul>
  5. 5. Keys To Treatment Planning <ul><li>Communication </li></ul><ul><ul><ul><li>Be clear. </li></ul></ul></ul><ul><ul><ul><li>Be specific. </li></ul></ul></ul><ul><li>Examples of Communication: </li></ul><ul><li>Be explicit in your requests: </li></ul><ul><ul><li>Instead of “leave spaces for restoration.” </li></ul></ul><ul><ul><ul><ul><li>Write: “Leave 2mm of space distal to the upper right lateral incisor for post orthodontic restoration.” </li></ul></ul></ul></ul><ul><ul><ul><li>Instead of “improve anterior esthetics” </li></ul></ul></ul><ul><ul><ul><ul><li>Write: “Add 5 degrees of mesial rotation to the upper left central and distal root tip to the upper left canine.” </li></ul></ul></ul></ul><ul><ul><ul><li>Instead of “Line up teeth with proper alignment” </li></ul></ul></ul><ul><ul><ul><ul><li>Write: “Rotate upper lateral incisor mesial in to line up with upper central.” </li></ul></ul></ul></ul>
  6. 6. 1. Invisalign Treated Arches <ul><li>Is there enough overjet to treat one arch only? </li></ul><ul><li>If expansion is needed, will it be easier to coordinate the movement if both arches are treated? </li></ul><ul><li>If anterior crossbite correction is needed, is it easier to coordinate if both arches are treated?. </li></ul>
  7. 7. 2. Do Not Move These Teeth <ul><li>Are all teeth marked that should not be moved? </li></ul>
  8. 8. 3. Do Not Place Attachments on These Teeth <ul><li>Have all facial / buccal restorations (esp. veneers & buccal alloys) been noted (even if teeth are not being moved)? </li></ul>
  9. 9. 4. Midline <ul><li>If a large midline correction is required, is IPR acceptable to resolve the midline shift? </li></ul>
  10. 10. 5. Overjet <ul><li>If a large overjet correction is required, is IPR or an A-P change acceptable to resolve the overjet? </li></ul>
  11. 11. 6. Overbite <ul><li>Is overbite correction required or only incisor leveling? </li></ul>
  12. 12. 7. A-P (Sagittal) Relationship <ul><li>Is current A-P relationship / posterior occlusion acceptable as it currently exists? </li></ul><ul><li>If distalization is desired, is patient willing to accept longer treatment time? </li></ul><ul><li>If A-P change is desired, are goals realistic?. </li></ul>
  13. 13. 8. Posterior Crossbite(s) <ul><li>If the crossbite is unilateral and many teeth are involved, then is the patient comfortable with the use of auxiliary techniques to resolve the crossbite? </li></ul>
  14. 14. 9. Resolve Spacing and Crowding <ul><li>Can all spacing be closed without losing overjet? </li></ul><ul><li>If space must be left, will I simply leave it or have it restored?. </li></ul>
  15. 15. 9. Resolve Spacing and Crowding <ul><li>Can tooth anatomy prohibit IPR (e.g. small narrow teeth)? </li></ul><ul><li>Do periodontal conditions prohibit proclination or expansion? </li></ul><ul><li>Is there a method of resolving crowding that should definitely be performed or not performed? </li></ul><ul><li>If extracting, is the patient comfortable with the use of auxiliary techniques to achieve an ideal finish?. </li></ul>
  16. 16. 10. Tooth Size Discrepancy <ul><li>If all spaces cannot be closed, can IPR be performed in the opposite arch to close the space </li></ul><ul><li>If not restoring to close spaces, where would it be best to leave space? </li></ul><ul><li>If performing a bonding or veneers, what position of the laterals would allow for best restoration?. </li></ul>
  17. 17. 11. Overcorrection <ul><li>Recommended at Case Refinement Stage </li></ul>
  18. 18. 12. Treatment Preferences <ul><li>Is the way I prefer to have this case set-up very different than what is listed in the current treatment preferences? </li></ul>
  19. 19. 13. ClinCheck Objectives <ul><li>Is the patient comfortable with the use of auxiliary techniques to achieve an ideal finish? </li></ul><ul><li>Real vs. Ideal is the key. </li></ul>
  20. 20. 14. Special Instructions <ul><li>Are there any restorative plans that should be noted? </li></ul><ul><li>Are there any attachment requests that are different than protocol (e.g. lingual, additional, etc.)? </li></ul><ul><li>Will black triangle reduction be necessary? </li></ul><ul><li>Are there periodontal concerns that I should note? </li></ul><ul><li>Was there pre-Invisalign treatment that would cause the occlusion to be different than the photos?. </li></ul>