This document summarizes keys to treatment planning for Invisalign cases, including understanding appliance limitations, incorporating auxiliary treatments into the ClinCheck plan, and clear communication between the orthodontist and Invisalign about treatment goals and specifics. It provides a checklist of questions for the orthodontist to consider when planning each individual case to ensure an ideal outcome.

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. Doctor Background Loma Linda University Dental School USC Dental School, Certificate in Orthodontics USC Graduate School, MS Craniofacial Biology Invisalign Premier Provider Over 260 cases submitted Email: [email_address] Phone #: 818-242-1173

3. Setting Treatment Goals An ideal outcome starts with with a good treatment plan. Keys to Treatment Planning with Invisalign. ClinCheck Quality Treatment Outcomes Treatment Planning Finishing

4. Keys To Treatment Planning Understand the appliance and difficult movements: Absolute extrusions Severe rotations of round teeth Large – span translations/extractions Recognize and incorporate solutions into the treatment plan Auxiliary Treatment IPR, Detail Pliers, Button Kit, Attachments, Elastics Strategic staging in ClinCheck Build in case refinement

5. Keys To Treatment Planning Communication Be clear. Be specific. Examples of Communication: Be explicit in your requests: Instead of “leave spaces for restoration.” Write: “Leave 2mm of space distal to the upper right lateral incisor for post orthodontic restoration.” Instead of “improve anterior esthetics” Write: “Add 5 degrees of mesial rotation to the upper left central and distal root tip to the upper left canine.” Instead of “Line up teeth with proper alignment” Write: “Rotate upper lateral incisor mesial in to line up with upper central.”

6. 1. Invisalign Treated Arches Is there enough overjet to treat one arch only? If expansion is needed, will it be easier to coordinate the movement if both arches are treated? If anterior crossbite correction is needed, is it easier to coordinate if both arches are treated?.

7. 2. Do Not Move These Teeth Are all teeth marked that should not be moved?

8. 3. Do Not Place Attachments on These Teeth Have all facial / buccal restorations (esp. veneers & buccal alloys) been noted (even if teeth are not being moved)?

9. 4. Midline If a large midline correction is required, is IPR acceptable to resolve the midline shift?

10. 5. Overjet If a large overjet correction is required, is IPR or an A-P change acceptable to resolve the overjet?

11. 6. Overbite Is overbite correction required or only incisor leveling?

12. 7. A-P (Sagittal) Relationship Is current A-P relationship / posterior occlusion acceptable as it currently exists? If distalization is desired, is patient willing to accept longer treatment time? If A-P change is desired, are goals realistic?.

13. 8. Posterior Crossbite(s) 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?

14. 9. Resolve Spacing and Crowding Can all spacing be closed without losing overjet? If space must be left, will I simply leave it or have it restored?.

15. 9. Resolve Spacing and Crowding Can tooth anatomy prohibit IPR (e.g. small narrow teeth)? Do periodontal conditions prohibit proclination or expansion? Is there a method of resolving crowding that should definitely be performed or not performed? If extracting, is the patient comfortable with the use of auxiliary techniques to achieve an ideal finish?.

16. 10. Tooth Size Discrepancy If all spaces cannot be closed, can IPR be performed in the opposite arch to close the space If not restoring to close spaces, where would it be best to leave space? If performing a bonding or veneers, what position of the laterals would allow for best restoration?.

17. 11. Overcorrection Recommended at Case Refinement Stage

18. 12. Treatment Preferences Is the way I prefer to have this case set-up very different than what is listed in the current treatment preferences?

19. 13. ClinCheck Objectives Is the patient comfortable with the use of auxiliary techniques to achieve an ideal finish? Real vs. Ideal is the key.

20. 14. Special Instructions Are there any restorative plans that should be noted? Are there any attachment requests that are different than protocol (e.g. lingual, additional, etc.)? Will black triangle reduction be necessary? Are there periodontal concerns that I should note? Was there pre-Invisalign treatment that would cause the occlusion to be different than the photos?.