L k. invisalign 2 yh

967 views

Published on

Treatment of a young female patient wit a combination of Invisalign and distalizing appliance. Well treated by one of our students under my supervision.
Please comment

0 Comments
4 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
967
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
78
Comments
0
Likes
4
Embeds 0
No embeds

No notes for slide

L k. invisalign 2 yh

  1. 1. Treatment Completed LK DMD IVDate: April 8th, 2012
  2. 2.  Age: 16 years old Sex: female C.C. “ I want my lower 4 teeth fixed” Pre-treatment
  3. 3.  Past medical history: NSF Medications: None Allergies: NKDA Past dental history: Last seen dentist 9m ago for exam and cleaning (referred by family dentist)  Brushes 2x/day and flosses 2x/week Oral hygiene: Fair (moderate plaque and calculus accumulation
  4. 4.  Facial Type: Normocephalic Facial Proprtions: UFH = LFH Facial Symmetry: Symmetrical
  5. 5.  Facial Profile: Slightly convex Nasolabial angle: Slightly obtuse Lips: Upper lip length is normal Lips normal at rest No upper incisors showing at rest
  6. 6.  Tongue at rest: WNL Swallowing pattern: WNL Muscles of mastication: WNL TMJ: Normal articulation Normal range of motion Normal muscles of mastication
  7. 7. Facial Symmetry Upper midline:No deviation Upper dental midline:No deviation Lower midline:No deviation Lower dental midline:Deviated 3 mm to the right Pre-treatment
  8. 8. Right Side Dental Midline Left SideMolar class I Upper: no deviation Molar class ICanine class I Lower: 3mm to right Canine class I Pre-treatment
  9. 9. 40-50 % Overbite Pre-treatment
  10. 10. Overjet Right: 4 mm Left: 2 mm Pre-treatment
  11. 11.  Teeth present: 17 to 27 and 37 to 47 Arch Shape Upper: Lower: Normal Normal Pre-treatment
  12. 12.  Soft Tissue Assessment  Fair oral hygiene Periodontal Status  PSR II; moderate gingivitis  Adequate attached gingiva Anterior crossbite: 1.2&4.2 Rotations 1.3 & 4.3 Pre-treatment
  13. 13. Intra Oral Examination Amount of Crowding Upper: Lower: Moderate Mild-Moderate Pre-treatment
  14. 14. Clinical Findings:- All permanent dentition except for third molars are erupted- Rotations 2.3, 3.3, 4.3- Normal condylar and ramus architecture Pre-treatment
  15. 15. Measurement Value Normal SDSKELETALSNA 86 81º 3SNB 80.5 78 3ANB 5.5 3 2Facial Angle 91.2 88 4Witts -0.8 2 2Mand. Plane Angle 30 33 3Y axis 62 60 4DENTO-ALVEOLARUpper inc. to NA 18 23 6Lower inc. to NB 27 27.5 5Upper inc./Lower 129.4 130 7incLower Inc. to 98 91.4 4Mand. Plane Pre-treatment
  16. 16.  Normal Curve of Spee For Maxilla Moderate Curve of Spee for Mandible Pre-treatment
  17. 17. Molar rotation: 16, 26, 36, 46 - normalAngle Classification: Right: Class I molar, Class I canine Left: Class I molar, Class I canineOverbite 40-50 %Overjet 4 mm (right), 2 mm (left) Pre-treatment
  18. 18.  Abnormal tip: 11 & 12(mesial), 21&22 (mesial) Abnormal torque: Labial: 22, 42 Lingual: 12, 11, 21, 32 ,31 ,41, 43 Rotation: 11 mesial, 12 mesial, 21 mesial, 22 mesial, 32 distal, 33 distal, 35 mesial, 36 mesial, 43 distal, 45 mesial Pre-treatment
  19. 19. Tooth Upper right Upper left IdealCentral I 9.1 9.3 8.85Lateral I 7.4 7.4 6.9Canine 8.2 8.1 7.88Tooth Lower right Lower left IdealCentral I 5.4 5.3 5.5Lateral I 6.3 6.3 6Canine 6.9 6.9 6.95∑UA = 49.5 mm∑LA = 37.1 mm∑LA / ∑UA = 37.1/49.5 = 74.9% (norm=77%) Pre-treatment
  20. 20.  DENTAL:  Position of the upper incisor in the relation to the maxilla (18, N = 23 ± 6): upper incisors slightly retroclined  Position of the lower incisor in relation to the mandible (27, N = 27.5 ± 5): normal  Lower incisor to the mandibular plane (98, N = 91.4 ± 4) : slightly proclined in relation to mandibular plane  Interincisal angle (129.4, N =130 ± 7): normal SKELETAL:  Position of the maxilla in relation to the cranial base (SNA = 86, N = 81± 3): slightly prognathic maxilla  Position of the mandible on relation to the cranial base (SNB = 80.5, N = 78 ± 3): normal  Relationship of the mandible and maxilla (ANB = 5.5, N = 3± 2): normal (CI skeletal pattern)  (Witts -0.8, 2± 2): normal (CI / slight C3 skeletal pattern)  Facial angle = 91.2, N = 88 ± 4: normal, slight vertical growth pattern  Mandibular plane angle (30, N = 33 ± 3): normal  Y axis (62, N = 60 ±4): normal growth pattern Pre-treatment
  21. 21.  Class I, type I malocclusion Very slight convex profile Crossbite (1.2 / 4.2) 40-50 % overbite 4mm (R) and 2mm (L) overjet Crowding in the anterior permanent teeth in both dental arches  Dento-alveolar / tooth mass discrepancy  Several rotated teeth Lower dental midline shifted 3 mm to the right Pre-treatment
  22. 22.  Maintain Class I occlusion Alleviate crowding Align anterior teeth Correct deviated dental midline Maintain overbite and overjet Preserve facial profile Address patient’s chief complaint and satisfy patient expectations (realistically)
  23. 23.  Invisalign on both arches - align/coordinate upper and lower arches - relieve anterior crossbite (Q1 / 4) - de-rotate teeth with the use of attachment buttons Interproximal stripping - aid in creating space and relieving the crowding present - shift the lower anteriors towards the left correcting dental midline shift
  24. 24.  NiTi archwire upper arch 2x4 only - align/coordinate upper and lower arches and midlines - de-rotate and align teeth Interproximal stripping - correct the moderate crowding present - shift the lower anteriors towards the left correcting dental midline shift
  25. 25.  Extraction of upper and lower first premolars Complete bracketing of the upper arch and lower arch - relieve crowding - de-rotate and align teeth - coordinate upper and lower arches/midlines
  26. 26.  Patient did not want upper and lower bracketing Complete bracketing is not done at the McGill Undergraduate Dental Clinic Selected: “Compromised Treatment Option #1” Invisalign with interproximal reduction - align teeth and both arches / midlines - relieve anterior crossbite
  27. 27. No mid-treatment phase: patient completedtreatment plan by orthodontist and Invisalign
  28. 28. Total treatment time: 1 year, 5 months
  29. 29.  Age: 18 years old Sex: female Post-Tx perspective: Patient is very happy with treatment results. - However, there are a few things that she would like to modify (later). Post-treatment
  30. 30.  No change from pre-treatment Facial Profile:  Nasolabial angle:  Lips: Slightly convex Slightly obtuse Upper lip normal Lips normal at rest No upper incisors show at rest
  31. 31. Right Side Dental Midline Left SideMolar class I Upper: no deviation Molar class ICanine class I Lower: no deviation Canine class I Post-treatment
  32. 32. Pre-treatment Post-treatment40-50 % Overbite 15 % Overbite Post-treatment
  33. 33. Overjet Right: 4 mm Left: 2 mm Right: 1 mm Left: 1 mm Pre-treatment Post-treatment
  34. 34.  Arch Shape Normal Normal Normal Normal Pre-treatment Post-treatment
  35. 35.  Crowding Moderate Normal Mild-Moderate Normal Pre-treatment Post-treatment
  36. 36.  Crossbite fixed (1.2 / 4.2) Crowding alleviated in both arches (due to rotated and misaligned teeth) Dental midline corrected (only 0.5mm deviation to the right) Overbite slightly reduced (only 15%) Overjet evened out to 1mm right and left Post-treatment
  37. 37. Permanent Dentition: Symmetric mandible; 8’s uneruptedNormal condylar and skeletal architecture Post-treatment
  38. 38. Measurement Value Normal SDSKELETALSNA 87 81º 3SNB 83 78 3ANB 4 3 2Facial Angle 87 88 4Witts 1 2 2Mand. Plane Angle 30 33 3Y axis 64 60 4DENTO-ALVEOLARUpper inc. to NA 22 23 6Lower inc. to NB 26 27.5 5Upper inc./Lower 127 130 7incLower Inc. to 94 91.4 4Mand. Plane Post-treatment
  39. 39. Pre-treatment Post-treatmentMeasurement Value Normal SD Measurement Value Normal SDSKELETAL SKELETALSNA 86 81º 3 SNA 87 81º 3SNB 80.5 78 3 SNB 83 78 3ANB 5.5 3 2 ANB 4 3 2Facial Angle 91.2 88 4 Facial Angle 87 88 4Witts -0.8 2 2 Witts 1 2 2Mand. Plane Angle 30 33 3 Mand. Plane Angle 32 33 3Y axis 62 60 4 Y axis 64 60 4DENTO-ALVEOLAR DENTO-ALVEOLARUpper inc. to NA 18 23 6 Upper inc. to NA 22 23 6Lower inc. to NB 27 27.5 5 Lower inc. to NB 26 27.5 5Upper inc./Lower inc 129.4 130 7 Upper inc./Lower inc 127 130 7Lower Inc. to Mand. Plane 98 91.4 4 Lower Inc. to Mand. Plane 94 91.4 4
  40. 40.  Normal Curve of Spee Post-treatment
  41. 41. Molar rotation: 16 (normal), 26 (normal) 36 (normal), 46 (distally - mild)Angle Classification: Right: Class I molar, class I canine Left: Class I molar, class I canineOverbite 15 %Overjet 1 mm (right), 1 mm (left) Post-treatment
  42. 42.  Abnormal tip: 12, 13, 14, 22 Abnormal torque: 12, 13 Rotation (molar): 46 (distally – mild) Post-treatment
  43. 43. Tooth Upper right Upper left IdealCentral I 8.7 8.8 8.85Lateral I 7.0 7.1 6.9Canine 7.6 7.8 7.88Tooth Lower right Lower left IdealCentral I 5.3 5.3 5.5Lateral I 5.9 6.0 6Canine 6.8 6.8 6.95∑UA = 47 mm∑LA = 36.1 mm∑LA / ∑UA = 36.1/47 = 76.8% (norm=77%) Post-treatment
  44. 44.  DENTAL:  Position of the upper incisor in the relation to the maxilla (22, N = 23 ± 6): normal  Position of the lower incisor in relation to the mandible (26, N = 27.5 ± 5): normal  Lower incisor to the mandibular plane (94, N = 91.4 ± 4) : normal  Interincisal angle (127, N =130 ± 7): normal SKELETAL:  Position of the maxilla in relation to the cranial base (SNA = 87, N = 81± 3): slightly prognathic maxilla  Position of the mandible on relation to the cranial base (SNB = 83, N = 78 ± 3): slightly prognathic mandible  Relationship of the mandible and maxilla (ANB = 4, N = 3± 2): normal (CI skeletal pattern)  (Witts 1, 2± 2): normal (CI skeletal pattern)  Facial angle = 87, N = 88 ± 4: normal  Mandibular plane angle (32, N = 33 ± 3): normal  Y axis (64, N = 60 ±4): normal / slight vertical growth pattern tendency Post-treatment
  45. 45.  Slight convex profile Class I molars and canines (right & left) Vertical growth pattern tendency Increased lower face height Post-treatment
  46. 46.  Patient is not satisfied with appearance of teeth 1.2 and 1.3 (slightly rotated and lingually inclined) She also feels that her 2 upper central incisors look “big”. Post-treatment
  47. 47.  Invisalign Refinement Trays  New Invisalgn impressions, Jetbite registration, photos, Panorex and Cephalometric radiographs were taken  Special instructions sent for tray fabrication:  1.2: labial root torque, rotation of mesial contact point into proper contact, extrusion of 1mm; possibly IPR  1.3: labial root torque, extrusion  2.2: rotation of contact point mesially  Refine 1st and 2nd premolars into occlusion  Possible re-alignment of dental midlines (at present, 0.5mm to the right) Post-treatment

×