Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Intrusion and
extrusion with
Invisalign
M.Sanoudos DDS,PhD
Force distribution & Type of tooth
movement
Optimal force
• The amount of force and the area of distribution
• The force d...
Force distribution & Type of tooth movement
Strain
• Strain is defined as percentage of
change in length of the material i...
Force distribution & Type of tooth movement
• Intrusion-very light forces-concentrated in a small
area
• Extrusion-Only ar...
Optimum forces for various tooth
movements-Proffit
6
Force Duration
• Sustained force- cyclic nucleotides appear- only after 4
hours
• Longer & constant the force- faster th...
Type force duration-force decay
• Continuous force
– Light- frontal resorption
– Heavy- undermining resorption- constant-f...
Mechanical Signaling
Is true intrusion a reality?
Am J Orthod Dentofacial Orthop 2006;130:709-14
Is true intrusion a reality?
Am J Orthod Dentofacial Orthop 2006;130:709-14
Is true intrusion a reality?
• CONCLUSIONS
● Limited evidence is available about the quantity of
attainable molar intrusio...
How good is Invisalign in moving teeth?
Am J Orthod Dentofacial Orthop 2009;135:27-35
How good is Invisalign in moving teeth? Part2
Am J Orthod Dentofacial Orthop 2009;135:27-35
How good is Invisalign in moving teeth?
How good is Invisalign in moving teeth?
Am J Orthod Dentofacial Orthop 2009;135:27-35
How good is Invisalign in moving teeth?
CONCLUSIONS
1. The mean accuracy of tooth movement with Invisalign was
41%. The mo...
How good is Invisalign in moving teeth?
4. Lingual crown tip was significantly more accurate
than labial crown tip, partic...
How good is Invisalign in moving teeth? Part2
Angle Orthodontist, Vol 85, No 5, 2015
How good is Invisalign in moving teeth? Part2
Angle Orthodontist, Vol 85, No 5, 2015
How good is Invisalign in moving teeth? Part2
Angle Orthodontist, Vol 85, No 5, 2015
How good is Invisalign in moving teeth? Part2
Most of the studies presented with methodological problems: small sample siz...
How good is Invisalign in moving teeth? Part2
• CAT is not effective in controlling rotations, especially of rounded
teeth...
Case 1 (From Invisalign Global Gallery)
• Treatment Information
• Age: 20
• Gender: M
• Invisalign Treatment Option: Full
...
Case 1 (From Invisalign Global
Gallery)
Case 1 (From Invisalign Global Gallery)
Case 1 Ceph data
(From Invisalign Global Gallery)
1. ANB 2.3
2. SNA 81.4
3. SNB 79.1 deg
4. Wits -1 mm
5. Μx/Md
differenti...
Case 1
(From Invisalign Global Gallery)
Case 1
(From Invisalign Global Gallery)
Case 1
(From Invisalign Global
Gallery)
Treatment Summary
Results Achieved:
 Maintained initial Class I occlusion
 Norma...
Case 2
Treatment Information
 Age: 60
 Gender: F
 Invisalign Treatment Option: Full
Chief Concern:
 Open bite and affe...
Case 2
Case 2
Case 2
Case 2
Case 2
Case 2 Treatment Summary
Results Achieved:
 Anterior and posterior crossbites closed
 Dental midlines corrected
 Class ...
Case 2 Total Treatment time:
 17 months
Number of Aligners:
 Maxillary: 51
 Mandibular: 51
Comments:
 4 TADs used to h...
Discussion
Upcoming SlideShare
Loading in …5
×

Intrusion and extrusion Invisalign

Presentation about reliablity of invisalign in intruding and extruding teeth

  • Be the first to comment

Intrusion and extrusion Invisalign

  1. 1. Intrusion and extrusion with Invisalign M.Sanoudos DDS,PhD
  2. 2. Force distribution & Type of tooth movement Optimal force • The amount of force and the area of distribution • The force distribution varies with the type of tooth movement
  3. 3. Force distribution & Type of tooth movement Strain • Strain is defined as percentage of change in length of the material in relation to original length. When a force is applied to any material, such as bone, it undergoes deformation. Strain = (change in length/original length) x100 • The amount of deformation in the material relative to its original length, is the strain. Forces should be kept low- high concentration of forces
  4. 4. Force distribution & Type of tooth movement • Intrusion-very light forces-concentrated in a small area • Extrusion-Only areas of tension
  5. 5. Optimum forces for various tooth movements-Proffit
  6. 6. 6 Force Duration • Sustained force- cyclic nucleotides appear- only after 4 hours • Longer & constant the force- faster the tooth movement
  7. 7. Type force duration-force decay • Continuous force – Light- frontal resorption – Heavy- undermining resorption- constant-further U.Resorption • Destructive to the PDL & tooth • Force decay – Light force-FR- no movement till activation – Heavy–UR- force drops-repair & regeneration occurs
  8. 8. Mechanical Signaling
  9. 9. Is true intrusion a reality? Am J Orthod Dentofacial Orthop 2006;130:709-14
  10. 10. Is true intrusion a reality? Am J Orthod Dentofacial Orthop 2006;130:709-14
  11. 11. Is true intrusion a reality? • CONCLUSIONS ● Limited evidence is available about the quantity of attainable molar intrusion. True molar intrusion appears to be achievable in the maxillary arch, but the amount of evidence is minimal. ● The clinical significance of the magnitude of the true intrusion reported for high-pull headgear is questionable as the sole treatment option to correct open bites in clinical situations. Am J Orthod Dentofacial Orthop 2006;130:709-14
  12. 12. How good is Invisalign in moving teeth? Am J Orthod Dentofacial Orthop 2009;135:27-35
  13. 13. How good is Invisalign in moving teeth? Part2 Am J Orthod Dentofacial Orthop 2009;135:27-35
  14. 14. How good is Invisalign in moving teeth?
  15. 15. How good is Invisalign in moving teeth? Am J Orthod Dentofacial Orthop 2009;135:27-35
  16. 16. How good is Invisalign in moving teeth? CONCLUSIONS 1. The mean accuracy of tooth movement with Invisalign was 41%. The most accurate tooth movement was lingual constriction (47.1%). The least accurate tooth movement was extrusion (29.6%). 2. Maxillary and mandibular canines achieved approximately one third of the predicted rotation. At rotational movements greater than 15°, the accuracy for the maxillary canines was significantly reduced. 3. With the exception of canine rotation, no tooth was significantly less accurate in movement. Am J Orthod Dentofacial Orthop 2009;135:27-35
  17. 17. How good is Invisalign in moving teeth? 4. Lingual crown tip was significantly more accurate than labial crown tip, particularly for the maxilary incisors. 5. The severity of pretreatment overjet might influence the accuracy of anterior tooth movement with Invisalign. 6. There was no statistical difference in accuracy between maxillary and mandibular teeth of the same type for any tooth movement studied. Am J Orthod Dentofacial Orthop 2009;135:27-35
  18. 18. How good is Invisalign in moving teeth? Part2 Angle Orthodontist, Vol 85, No 5, 2015
  19. 19. How good is Invisalign in moving teeth? Part2 Angle Orthodontist, Vol 85, No 5, 2015
  20. 20. How good is Invisalign in moving teeth? Part2 Angle Orthodontist, Vol 85, No 5, 2015
  21. 21. How good is Invisalign in moving teeth? Part2 Most of the studies presented with methodological problems: small sample size, bias and confounding variables, lack of method error analysis, blinding in measurements, and deficient or missing statistical methods. The quality level of the studies was notsufficient to draw any evidence-based conclusions • CAT is an effective procedure that is able to align and level the arches in non-growing subjects. • The anterior intrusion movement achievable with CAT is comparable to that reported for the straight wire technique. • CAT is not effective in controlling anterior extrusion movement. Contrasting results have been reported in relation to the posterior vertical control, and a definite conclusion cannot be drawn.
  22. 22. How good is Invisalign in moving teeth? Part2 • CAT is not effective in controlling rotations, especially of rounded teeth. • CAT is effective in controlling upper molar bodily movement when a distalization of 1.5 mm has been prescribed. • CAT is not based on aligners alone. It requires the use of auxiliaries (attachments, interarch elastics, IPR, altered aligner geometries) to improve the predictability of orthodontic movement. Angle Orthodontist, Vol 85, No 5, 2015
  23. 23. Case 1 (From Invisalign Global Gallery) • Treatment Information • Age: 20 • Gender: M • Invisalign Treatment Option: Full • Diagnostic Summary: • Class I relationship • Anterior open bite • Crowding • Use of: • Intrusion • Extrusion • IPR • TADs inserted buccally between 1.6 (UR6) and 1.7 (UR7), and between 2.6 (UL6) and 2.7 (UL7), and lingually between 1.5 (UR5) and 1.6 (UR6), and between 2.5 (UL5) and 2.6 (UL6) for 20 months • Elastics • Optimized Extrusion • Optimized Rotation
  24. 24. Case 1 (From Invisalign Global Gallery)
  25. 25. Case 1 (From Invisalign Global Gallery)
  26. 26. Case 1 Ceph data (From Invisalign Global Gallery) 1. ANB 2.3 2. SNA 81.4 3. SNB 79.1 deg 4. Wits -1 mm 5. Μx/Md differential 47 mm 6. LAFH 91.3 mm 7. MP-SN 35.5 deg 8. IMPA 86.4 deg 9. UI-SN 105.5 deg
  27. 27. Case 1 (From Invisalign Global Gallery)
  28. 28. Case 1 (From Invisalign Global Gallery)
  29. 29. Case 1 (From Invisalign Global Gallery) Treatment Summary Results Achieved:  Maintained initial Class I occlusion  Normal overjet and overbite achieved  All treatment goals were achieved Total treatment time:  24 months Number of Aligners:  Maxillary: 42+27=69  Mandibular: 42+27=69 Comments:  Orthognathic surgery avoided Retention:  Maxillary: Vivera retainer  Mandibular: Vivera retainer
  30. 30. Case 2 Treatment Information  Age: 60  Gender: F  Invisalign Treatment Option: Full Chief Concern:  Open bite and affected speech Diagnostic Summary:  All permanent dentition present  History of severe bruxism  History of TMJ with severe pain (~2 years prior to orthodontic evaluation) Treatment Plan and ClinCheck Analysis: • TADs to intrude maxillary posterior 1st, 2nd, and 3rd molars  Extrude upper 2-2 by 1mm  Distalize upper left quadrant with precision cut  Button for class II elastics on the left side to correct class II occlusion  Patient strongly advised but declined all 3rd molars extraction –  Maxillary 3rd molars finally extracted after completion of Invisalign treatment Use of:  Distalization  Extrusion  Intrusion
  31. 31. Case 2
  32. 32. Case 2
  33. 33. Case 2
  34. 34. Case 2
  35. 35. Case 2
  36. 36. Case 2 Treatment Summary Results Achieved:  Anterior and posterior crossbites closed  Dental midlines corrected  Class II malocclusion on left side corrected  Unable to extrude upper anterior teeth since patient declined to allow attachment placement on upper 2-2; results were obtained by intruding posterior dentition only  Mandible auto-rotated  Overjet and overbite corrected  Patient extracted U8's after completion of treatment; open-bite closed despite presence throughout treatment  11 TADs placed due to patient's uncooperation with foods and likely unfavorable bone quality
  37. 37. Case 2 Total Treatment time:  17 months Number of Aligners:  Maxillary: 51  Mandibular: 51 Comments:  4 TADs used to help intrude maxillary 1st, 2nd, and 3rd molars  Class II elastics used to correct class II on the left side Retention:  Maxillary: Other clear • Mandibular: Other clear
  38. 38. Discussion

×