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Incisor intrusion with invisalign treatment


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Incisor intrusion with invisalign treatment

  1. 1. ©2006 JCO, Inc. May not be distributed without permission. www.jco-online.comCASE REPORTIncisor Intrusion with Invisalign Treatmentof an Adult Periodontal PatientGAETANO TURATTI, DDS, DOSRANDOL WOMACK, DDSPIETRO BRACCO, MD, DDS, DOSO rthodontic intrusion can be effective in adult patientswith periodontal disease,1,2 as Diagnosis and Treatment Planning The final ClinCheck** pro- vided 15 aligners for the upper arch and 10 for the lower (Fig. A 43-year-old female pre-long as light, continuous forces 2). The predicted duration of sented with extruded, protrusive,are used and excellent oral hy- treatment was about eight and labially inclined upper in-giene is maintained.3,4 Such months. cisors and generalized anteriortreatment can reduce infrabony spacing (Fig. 1). A fixed prosthe-defects and improve periodontal sis had replaced the upper right Treatment Progresshealth,5-7 but requires a multi- bicuspids and molars. Bleedingdisciplinary approach8,9 and a Scaling and root planing was evident on periodontal prob-highly motivated patient. were performed before the start ing, and the patient had a flat Stable posterior anchorage of orthodontic treatment, with upper labial frenum.can be difficult to achieve in pa- the scaling repeated every eight Invisalign treatment wastients with missing teeth.10 Al- weeks. planned for derotation and intru-though skeletal anchorage may The first through 10th sion of the upper incisors and ca-be useful, the following case nines and uprighting of the upperdemonstrates intrusion of the right central incisor. The lowerupper incisors using only remov- *Registered trademark of Align Technology, arch required slight intercanine Inc., 851 Martin Ave., Santa Clara, CAable Invisalign* appliances in an expansion to allow the alignment patient with periodontal and uprighting of the upper in- **Trademark of Align Technology, Inc., 851disease. cisors. Martin Ave., Santa Clara, CA 95050.Dr. Turatti is in the private practice of orthodontics at via F. Pao-lini 12, 10138 Turin, Italy. Dr. Womack is an Associate Profes-sor, Orthodontic Department, Arthur A. Dugoni School of Dent-istry, University of the Pacific, San Francisco; he has presentededucational workshops for Align Technology as an independentcontractor. Dr. Bracco is Chairman, Department of Orthodontics,University of Turin, Italy. E-mail Dr. Turatti at Dr. Turatti Dr. Womack Dr. BraccoVOLUME XL NUMBER 3 © 2006 JCO, Inc. 171
  2. 2. Incisor Intrusion with Invisalign Treatment of an Adult Periodontal Patientaligners were worn for 15 days while the last lower aligner was Discussioneach, except that a frenectomy being worn, to allow root move-was scheduled during the sixth ments. At the end of active treat- Invisalign appliances pro-aligner period to reshape the gin- ment, the patient wore the last set vided a viable alternative to con-gival marginal without traction of aligners for an additional four ventional orthodontic intrusionfrom the upper frenum (Fig. 3). weeks. in this patient, aligning the ex-This aligner was worn for three The entire Invisalign treat- truded incisors in a relativelyweeks as the tissue healed. ment lasted 11 months (Fig. 4). short time with no need to re- The last five upper aligners Fixed lingual retainers were then move the posterior prosthesis.were changed every three weeks, placed in both arches. The post-treatment radiographsFig. 1 43-year-old female patient with extruded, protrusive, and labially inclined upper incisors, prostheticreplacement of upper right posterior segment, and periodontal disease before treatment.172 JCO/MARCH 2006
  3. 3. Turatti, Womack, and Bracco Fig. 2 Invisalign treatment planning with ClinCheck.Fig. 3 Frenectomy performed to reshape gingival margin without trac-tion from upper frenum. before after Fig. 4 Patient after 11 months of Invisalign treatment.VOLUME XL NUMBER 3 173
  4. 4. Incisor Intrusion with Invisalign Treatment of an Adult Periodontal Patientclearly showed upper incisor in- REFERENCES Assessment and description of the treat- ment needs of adult patients for ortho-trusion and a reduction of the in- dontic therapy, III. Characteristics of thefrabony defect. 1. Melsen, B.; Agerbaek, N.; and Marken- multiple provider group, Int. J. Adult Moving the teeth at a rate stam, G.: Intrusion of incisors in adult Orthod. Orthog. Surg. 1:251-274, 1986. patients with marginal bone loss, Am. J. 10. Burstone, C.J.: Deep overbite correctionof about .25mm per aligner, Orthod. 96:232-241, 1989. by intrusion, Am. J. Orthod. 72:1-22,Invisalign applies a light, contin- 2. Cardaropoli, D.; Re, S.; Corrente, G.; 1977.uous force.11 Attachments are and Abundo, R.: Intrusion of migrated 11. Clements, K.M.; Bollen, A.M.; Huang, incisors with infrabony defects in adult G.; King, G.; Hujoel, P.; and Ma, T.:bonded to the teeth adjacent to periodontal patients, Am. J. Orthod. Activation and material stiffness ofthe extruded teeth to provide a 120:671-675, 2001. sequential removable orthodontic appli-mechanical lock for the aligners 3. Wennstrom, J.L.; Stokland, B.L.; Ny- ances, Part 2: Dental improvements, man, S.; and Thilander, B.: Periodontal Am. J. Orthod. 124:502-508, 2003.and to allow pure sectional intru- tissue response to orthodontic move- 12. Taylor, M.G.; McGorray, S.P.; Durrett,sion, using the same biomechan- ment of teeth with infrabony pockets, S.; Pavlov, S.; Downey, N.; Lenk, M.;ics as the segmented-arch tech- Am. J. Orthod. 103:313-319, 1993. Oxford, E.; Dolce, C.; and Wheeler, 4. Boyd, R.L.; Leggott, P.J.; Quinn, R.S.; T.T.: Effect of Invisalign aligners onnique. The aligner dissipates the Eakle, W.S.; and Chambers, D.: Perio- periodontal tissues, J. Dent. Res. 82reactive force over the entire dontal implications of orthodontic treat- (Spec. Iss. A):1483, 2003.posterior segment, which serves ment in adults with reduced or normal periodontal tissues versus adolescents,as the anchorage unit. Am. J. Orthod. 96:191-198, 1989. In contrast to fixed ortho- 5. Thilander, B.: Infrabony pockets and re-dontic appliances, the aligners duced alveolar bone height in relation to orthodontic therapy, Semin. Orthod.can be removed for eating and 2:55-61, 1996.brushing, allowing optimal daily 6. Polson, A.; Caton, J.; Polson, A.P.; Ny-hygiene.12 The comfortable, es- man, S.; Novak, J.; and Reed, B.: Perio- dontal response after tooth movementthetic appliances have been en- into infrabony defects, J. Periodontol.thusiastically accepted by pa- 55:197-202, 1984.tients. Chairtime for aligner re- 7. Boyd, R.L. and Baumrind, S.: Perio- dontal considerations in the use of bondsplacement is minimal, and the or bands on molars in adolescents andclinician can compare the pa- adults, Angle Orthod. 62:117-126, 1992.tient’s results with the virtual 8. Vanarsdall, R.L. Jr.: Adjunctive ortho- dontics for the generalist, J. Tenn. Dent.ClinCheck images to immediate- Assoc. 59:15-18, verify treatment progress. 9. Musich, D.R. and Crossetti, H.W.:174 JCO/MARCH 2006