This is an interesting orthodontic case which I treated with Invisalign. Some complex tooth movements which were managed using precision attachments. I am sure that many of my colleagues would have used another appliance or treatment plan to correct this case. This could have been an extraction case or even a more ortho-restorative involved case. I chose a minimally invasive approach to achieve a satisfactory result.

1. Treatment Information
Patient: R.W
Age: 43
Gender: F
Invisalign Treatment Option: Full
Case treated by : Dr Raman Aulakh BDS MSc Orth
CL II DIV 2 ,SEVERE CROWDING, DEEP-BITE,
MISSING UR2, MICRODONTIC UL2

3. Pre-treatment photos

6. Clincheck images [before and after]

7. CLINCHECK ANALYSIS
• Upper central incisors moved with torque, intrusion and retraction.
• Upper lateral incisor UL2 extruded combined with controlled tip.
• Expansion and change of square arch forms in both arches.
• Use of precision attachments as required to de-rotate, extrude and
torque. Also used for anchorage in deep correction..
• Interproximal reduction of lower anterior teeth to control amount of
lower incisor proclination and avoid extraction treatment. [0.2mm from
mesial and distal of each contact point of LL3,LL2,LL1,LR1,LR2,LR3]

8. Precision Attachments Used
Pre – G5 case

9. Post-ortho photos

10. Smile improvement:
pre-ortho, post-ortho, post-restorative

11. TREATMENT SUMMARY
Results Achieved:
• Overjet controlled.
• Buccal occlusion maintained.
• Crowding resolved
Total treatment time:
• 24 months
Number of Aligners:
• Maxillary: 37 + (R 13)
• Mandibular: 31 + (R 10)
Comments:
• Good aesthetic result with
minimal restorative work
required afterwards.
• Stability issue due to lower
incisor proclination
• Recession concern: biotype limit
• Anterior IPR limit reached.
Retention:
• Maxillary:
Hawley retainer
Fixed retainer 3-3
• Mandibular:
Hawley retainer
Fixed wire retainer 3-3

12. Thank you !
Dr Raman Aulakh BDS MSc Orth
Specialist Orthodontist
Post-graduate Tutor [Aesthetic Dentistry]
Clinical Speaker Invisalign
www.ramanaulakh.com