2. What Is Invisalign®?
Aesthetic orthodontic treatment developed for
adults and teens who can benefit from straight
teeth
A series of clear, custom made, removable Aligners
created to effectively move teeth into
their desired position
Combines proven orthodontic science with
3-D computer graphics to project tooth
movement.
3. • Invisalign is designed, manufactured, and marketed
by Align Technology from 1999 onwards.
• Instead of necessitating a new set-up for each new
aligner, creation of an Invisalign appliance involves
computer-aided-design and computer-aided-
manufacturing (CAD-CAM) technology, combined
with laboratory techniques, to fabricate a series of
positioners (aligners) that can move teeth in small
increments of about 0.25 to 0.3 mm.
Made of thin, see-through plastic
Fit over the buccal, lingual, and occlusal surfaces
of teeth
4. What Is Invisalign®?
• Aligners are worn
24 hours and removed
for eating, drinking,
brushing and flossing
• Patients wear each
set of aligners in
two-week intervals.
7. Aligners are sent to the
doctor office
Aligner Delivery
Fabricating
Aligners
Doctor sends patient
records and treatment plan
to Align
PVS Impressions
Align scans impressions
and creates 3 D digital
models
3D Model
Each tooth in the digital
model is cut virtually.
Technicians and software
stage serial movement to
create simulation of
treatment according to
doctor's instructions
ClinCheck
Using advanced
manufacturing technology,
resin models are created
for each virtual stage
Resin Models
Plastic is formed over each
resin model to create an
aligner for every stage
planned and approved by
the doctor
Aligner Fabrication
9. ClinCheck Software
• Provides a virtual visualization
of treatment plan
• Shows how the teeth are
expected to move throughout
treatment, and what the
treatment outcome will look
like
• Depending on the product
selected, various features of
the software may or may not
be presented
10. 10
Attachments
Attachments
• Three dimensional shapes added to
tooth geometry to enhance the
interaction between an aligner and
the teeth
• Provides movement control or
retention
• Chairside procedure done at the
start of treatment using a template
11. Power Ridges
Power Ridges
• Three dimensional shapes added
to the aligner to enhance the
interaction between an aligner
and the teeth
• Helps deliver lingual root
movements for upper incisors
• Software determines whether or
not power ridges are designed
into the aligners
12. Interproximal Reduction
(IPR)
• Interproximal reduction
of enamel
• Done chairside during
the treatment period
when additional space is
needed
• Information and
instructions are
provided with each
individual case
13. Align Clinical Set Up
Protocols
Align Clinical Set Up Protocols
• Based on over a million cases in
treatment
• Defaults used by the software and
Align technicians to create the
prescribed treatment plan
• Examples include:
• Speed of each tooth movement
• Location and timing of IPR
• Location and type of
attachments
14. Case Refinement
• Part of the Invisalign process to help ensure the
expected patient outcomes
• An option to order additional aligners before
the end of Invisalign Treatment if additional
tooth movement is desired
• This “fine tuning” should be expected as part of
overall treatment plan with most Invisalign
treatments
15. Aligner Tracking
Refers to the fit of aligners on the teeth
If aligners are NOT
“tracking,” this means
there are gaps/fit issues
16. Invisalign aligners and Vivera retainers are
produced from USP Class VI medical grade,
high molecular weight, polyurethane
resins.
Aligners and retainers do not contain
Bisphenol-A nor phthalate plasticizers
17. PATIENT Benefits
• Removable
• (nearly) Invisible
• Comfortable
• Brush and
floss normally
• No food restrictions
• Minimal changes to
activity and lifestyle
18. Potential CLINICAL Benefits
Reduce Risk of
Decalcification
Position Teeth to Optimize
Restorative Results
Limit Occlusal Abrasion from
Para-Functional Habits
Visualize Your Treatment
Plan Before You Start
Straightening Teeth May
Improve Overall Oral Health
19. commonly used for
• Spacing
– Mild, Moderate and Severe Spacing
– Diastema
• Crowding
– Mild, Moderate and Severe Crowding
– Crossbite and Incisor Extraction
• Other
– Open Bite
– Deep Bite
– Class II Correction
– Restorative Treatment Plan
20. Difficult
Moderate
Aligner Capabilities and Patient Selection
Aligner Only
Doctor is likely to achieve
the desired patient
outcome with aligners
only
Buttons & Elastics
maybe required
Doctor may need buttons
& elastics to achieve more
challenging movements
planned
Doctor may need other
orthodontic techniques
(ie fixed appliances) to
achieve more
challenging
movements planned
Other Orthodontic
techniques maybe
required
Easy
21. Challenging Movements with Aligners Only
Significant
Rotations
(especially upper laterals,
bicuspids and molars)
Vertical Changes
Anterior-
Posterior
Changes
22. Rotation Aligner Only
Buttons & Elastics Maybe
Required
Other Orthodontic
techniques maybe
required
(i.e fixed appliances)
Upper & Lower Canines ≤ 45 deg 45- 55 deg 55+ deg
Upper Central Incisors ≤ 40 deg 40- 50 deg 50+ deg
Lower Incisors ≤ 40 deg 40- 50 deg 50+ deg
Upper Lateral Incisors ≤ 30 deg 30- 40 deg 40+ deg
Upper & Lower Bicuspids ≤ 30 deg 30- 40 deg 40+ deg
Upper & Lower Molars ≤ 20 deg 20- 30 deg 30+ deg
Extrusion & Intrusion Aligner Only
Buttons & Elastics Maybe
Required
Other Orthodontic
techniques maybe
required
(i.e. fixed appliances)
Anterior Teeth (Incisors & Canines) ≤ 2.5 mm 2.5- 3.5 mm 3.5+ mm
Bicuspids ≤ .5 mm .5- 1 mm 1+ mm
Molars ≤ .5 mm .5- 1 mm 1+ mm
Root Movement Aligner Only
Buttons & Elastics Maybe
Required
Other Orthodontic
techniques maybe
required
(i.e. fixed appliances)
Any Single Tooth (measured by the displacement
of the center of the root)
≤ 3.5 mm 3.5- 4 mm 4+ mm
DISCLAIMER: The clinical product recommendations are based on Align Technology knowledge and expertise with its products and processes. Actual results may vary
depending among other things on skill of dental practitioner. Clinical decisions remain the responsibility of the treating doctor
Tooth Movement by Degree of Difficulty
23. A shorter-duration Invisalign treatment for pre-restorative work and
treating minor crowding/spacing malocclusions
Clear thermoplastic retainers that are designed to be used after
completing orthodontic or cosmetic treatment.
The Invisalign family of products are designed to provide you with a full range of choices to address your patients’
needs effectively and confidently.
Foundation product. Provides a full spectrum of treatment options and
may require advanced experience and/or adjuncts to achieve ideal results
for complex case types.
The Invisalign Product Family
Invisalign Full
Invisalign Express
Provides doctors with additional product support throughout treatment
process to help deliver patient outcomes you expect .
Invisalign Assist
Unique features for the non-adult patient.
Invisalign Teen
Vivera Retainers
24. Prior to Initiating Invisalign…
• All necessary restorative work
must be completed
• No active periodontal disease
27. • Prior to impressions
• Retainer necessary
• Buttons placed
lingual of 4 and 6
• 5 and 6 bonded together
to increase anchorage
• C-chain placed 4-6
Addressing Rotations BEFORE Invisalign
29. Records - Preparation
• Impressions
• Bite Registration
• Photographs
• X-rays
• Prescription Form
30. Records Preparation
Submitting the Perfect Impression
• Key to success with proper-fitting aligners
begins with great impression
• Impressions must always be taken using PVS
impression material
• Any other material such as polyethers
(Impregum) or alginates (Jeltrate) are not
acceptable
32. Benefits of Modified 1-Step Technique
• No need to make custom tray
• Forces material to get distal to 2nd and
3rd molars if present
• Can take impression in a moist field
• Maximum chair efficiency
• Lower cost impression
• Minimize re-takes
33. Helpful Suggestion…mouth rinse
• PVS material is hydrophilic
• Saliva can cause voids in the material
• Suggestion:
– Small cup of mouth rinse (Listerine) for
patient to rinse, swish and spit
immediately prior to tray insertion
34. Impression
Examination
• All margins appear crisp and
clean
• Material is > 2mm beyond
free gingival margin (CEJ if
recession is present) on
buccal/lingual surfaces
• All cusps & incisal edges
show clearly
• No presence of fold, wrinkles,
draws, or voids
• No tray or thin wall of
material present
• All facial & lingual anatomy
present
If occlusal contact with tray, ok if less
than 1mm
35.
36. Records - Preparation
• Impressions
• Bite Registration
• Photographs
• X-rays
• Prescription Form
49. Records - Submission
• Invisalign Orthodontic Records Submission Box Contents:
1. Original PVS upper and lower impressions
2. Original PVS bite registration
3. Duplicate photos and x-rays
4. Prescription Form
ONLINE submission
of Photos, X-rays, & form PREFERRED
51. Clincheck Virtual Treatment Plan
• Technician utilizes treatment
form and images of patient
impression scans in
conjunction with Clincheck
software to generate
computerized virtual
treatment plan of all stages
from start to finish
52. How teeth in general will move—all together or individual teeth
moving at various times
Align's Clinical Set Up Protocols
General Staging
Tooth Velocity
IPR
Attachments
How fast/slow should individual teeth be staged to move in each
aligner
When and where will additional space be necessary during the
treatment period so teeth have room to move towards their
ideal positions
Where and what type of attachments will be necessary to aid in
tooth movement/aligner retention?
Power Ridges™ When lingual root torque is needed on upper incisors
53. Cases are staged to enable combination movements
to occur simultaneously for each tooth
Align's Clinical Set Up Protocols
General Staging
Tooth Velocity
IPR
Power Ridges™
Attachments
54. Using digital dental reference points, ClinCheck® set-
ups are designed to factor in a combination of root
movement, crown movement and rotational speed
at every aligner stage.
Maximum velocity is .25 mm linear and 2 degrees
for rotations per stage
Align's Clinical Set Up Protocols
General Staging
Tooth Velocity
IPR
Power Ridges™
Attachments
55. In crowding cases, IPR is set-up in later stages of
treatment when space is needed and when tooth
contacts requiring IPR may be easier to access.
Align's Clinical Set Up Protocols
General Staging
Tooth Velocity
IPR
Power Ridges™
Attachments
Less predictable
More predictable
56. Software detects when optimized force is needed for
uprighting retroclined upper incisors
Align's Clinical Set Up Protocols
General Staging
Tooth Velocity
IPR
Power Ridges™
Attachments
Force
Force
57. Software detects a variety of clinical situations when
attachments will be needed. All attachments serve a
purpose during the duration of the treatment period
since all teeth are moving simultaneously.
Align's Clinical Set Up Protocols
General Staging
Tooth Velocity
IPR
Power Ridges™
Attachments
58. Attachments can be...
Passive Tooth doesn’t move:
• Intrusion Anchorage
• Aligner Retentiveness
Active Tooth moves:
• Rotations of round teeth
• Root Control
• Extrusion
59. Types of Attachments
Align Technology has four Optimized
Attachments that will be applied by default:
Cuspid
Extrusion
Mesial Cuspid
Rotation
Incisor
Extrusion
Distal Cuspid
Rotation
For upper and lower canines & incisors
61. There are very few reasons we
would ever want to modify or
change these protocols
62. Potential Reasons to Modify Default IPR
The treating clinician, needs to determine if the amount,
location, and timing of IPR proposed is appropriate
Orthodontist want the IPR to be spread out or relocated
Enamel may be too thin for IPR created in the set up (check x-rays)
Potential Reasons to Modify Default IPR
Poor oral hygiene
Prior orthodontics with IPR
66. 2. Composite
Ivoclar Tetric EvoCeram
• Classification - Nanohybrid
• Latest composite technology
• Smaller particle size results in
higher packing density & lower
shrinkage
• Translucent color (matches well
with any tooth shade)
• Ease-of-use – handles easily
due to non-tacky characteristics
1. Bonding Agent
GC America G-Bond
• 7th generation adhesive
• Latest adhesive technology
• Self-etching (for general use)
• However, pre-etching is
recommended (for
attachments) due to use on
uncut enamel
• Ease-of-use - Fewer clinical
steps compared to some
earlier generation materials
The Invisalign Attachment Kit contains two items:
(enough for 3 typical patients)
Attachment Kit
80. IPR Interproximal Reduction
• Based on computerized measurements,
staging, and tooth movements, IPR is
sometimes required to allow the teeth to
align
• IPR is specified by amount, and by the stage
when it is required.
84. Remove the amount of
tooth structure and
record on the form.
Single aligner number
per contact by which all
IPR should be completed
makes the IPR timing
more easy to remember.
92. Initial Treatment - Aligner Delivery
Delivery to Patient
• Deliver aligners and
Starter Kit (with
instructions for use) to
the patient
• Patient wears the
aligners in two-week
intervals until
treatment is complete.
104. Interarch Techniques
Extrusion
• Prior to impressions
• Place three composite or
metal buttons
• Have patient wear triangular
elastic until occlusion locks in
• Then take PVS impressions for
aligners.
Triangulation before aligners are placed
106. IntraArch One Button Technique
Extrusion
• Two slits cut in aligner
lingual of targeted
tooth
• Portion of aligner on
facial of targeted tooth
cut away
107. IntraArch One Button Technique
Extrusion
• Bond clear button
to gingival area of
clinical crown
• Place IntraArch
elastic from
button, across
incisal edge, to
slits
110. Important Note:
• If Class II Correction is requested,
Align will assume use ofClass II Elastics
from the initial aligner for the duration
of treatment
• In the final ClinCheck, the technician
will set up a “Virtual Jump”
• The Final Stage will show a full Class II
correction (Virtual Jump)
113. Mid-Course Correction*
Re-start as a result of:
1. Poor Patient Compliance
2. New Dental Work
3. Change in Treatment Goals after
ClinCheck acceptance or mid-treatment
114. Residual Spacing and Crowding Solutions
• Case refinement aligners (spacing and
crowding)
• Detail pliers (crowding only)
115. Correcting Minor Rotations
• Detail Pliers
• Overcorrection at Case Refinement
• Key is if desired movement is already
present in aligner
• IPR performed if space is needed.
116. Detail Pliers
• Minor Anterior Rotations
• Tightens light
interproximal contacts
• Enhances aligner
retention in undercut
regions
• Creates Pressure points
up to 1mm in depth.
124. Finish- Invisalign Detail & Eraser Pliers
• Heat-free and adjustable
• Detail Pliers
• To modify minor discrepancies in alignment
• To nudge teeth into positions already built into
aligner
• To increase retention
• Eraser Pliers
Remove or reposition pressure points as
desired.
125.
126. Posterior Open Bite
Potential Causes:
• Anterior interference
• Insufficient leveling
• Bowing of arch due to
insufficient IPR
• Material thickness
128. Posterior Open Bite
• Trim aligners distal
to 2nd bicuspid
• Allows passive
eruption (settling)
129. Case Refinement
Refinement is an option to order additional aligners at
or near the end of treatment if further tooth
movement is desired.
Reasons Refinement is needed:
– Tight contacts
– Excessive IPR and/or residual spaces left at the end
of treatment
– Modification not communicated in ClinCheck setup
– Patient compliance
– Additional fine-tuning requests by the patient
135. Support for Pontics
• Provides an aesthetic solution for the
masking of dental spaces while
providing orthodontic retention of the
entire arch
• Preserves spaces and prevent the
collapse of neighboring teeth
• An aesthetic solution for the masking
of dental spaces after the placement
of implants.
140. • Provided at no charge.
• Addresses lost or broken
aligners during the
treatment period.
6 Free Replacement Aligners*
* Some conditions apply.
141. The tab extends over the
mesial cusp of the 2nd
molar to help prevent
supra-eruption.
Occlusal View
Eruption Tab
The height of the tab
matches the occlusal
plane anticipating the
full eruption of the
second molar and as
molar erupts, the tab
acts as a stop to help
prevent supra-eruption.
