Treating a Complex Case with Invisalign®
Clear aligners offer a clear advantage in restoring a healthy mouth and smile.
In May 2007, a 30-year-old woman presented at the author’s practice in Yukon, Oklahoma, for an orthodontic consultation. She had specifically requested Invisalign® treatment. At some point in the past, two upper premolars had been removed. There was a 9-mm diastema and super-erupted central incisors. Her upper arch was asymmetrical. Significant lower crowding persisted, with the left canine completely out of occlusion. Notably, she also had both an anterior and posterior crossbite (Figure 1).
Although the author had successfully used Invisalign in several prior cases, none of those cases had approached the complexity of this case. Even if all of these issues could be corrected, retention was a significant concern. However, in spite of her reservations and based on the patient’s request and confidence, the author made the decision to move ahead.
Impressions were taken and sent to the Invisalign laboratory, which delivered a ClinCheck treatment plan for the author to review and approve. Upon treatment plan approval, the first set of aligners was delivered to the office. Thereafter, the patient returned to the dental office every 6 weeks for a routine check.
As treatment progressed, the patient’s visits became the highlight of the week for the office. The staff would immediately want to see the progress and took photographs each time. While the clinical team was focused on the treatment plan, which included closing the diastema and rotating her lower teeth, no one could fail to notice the gradual change in the patient’s personality. As her smile improved, she became more outgoing and confident.
The Invisalign process was smooth for the clinical team and comfortable for the patient. Treatment progressed according to plan. In the first 18 weeks, the focus was on closing the diastema, which first required rotating and intruding the central incisors to improve the angulation.
Once the central incisors were rotated and intruded, the diastema closed over time while her upper arch was widened to better accommodate her teeth. Meanwhile, the lower teeth were being rotated to relieve crowding, align them, and eliminate the crossbite. At the end of 42 weeks the patient was happy, but refinement was needed to bring the lower teeth into a more ideal occlusion.
Over the next 12 months, the lower canines were rotated to eliminate crowding. At the same time, the final space between the central incisors closed to eliminate the diastema. The entire process was successful because the patient was compliant. The total treatment took 25 months with no extractions.
Since treatment was completed in 2009, the patient wore an Invisalign retainer. In 2011, 2 years after treatment completion, her teeth have stayed in place so well that when the author recently ordered a Vivera retainer from the ClinCheck treatment plan, it fit perfectly.
The most obvious change is the patient’s smile (Figure 2). Intruding the central incisors and removing the flared angle helped balance her facial muscles. However, more importantly, straightening her teeth has had a significant impact on the health of her mouth. Her severe crowding and spacing issues were leading to increased protrusion of the central incisors. The crossbite correction prevented future damage associated with excessive forces on the teeth.
For the author, if any doubt remained about the efficacy of Invisalign for complex cases, this case certainly eliminated it. Invisalign is an effective treatment modality for simple and complex cases. This patient gave the entire dental team more confidence to take on demanding cases using Invisalign, and they have. If patients are compliant, the treatment works well.
Most patients would prefer to keep their natural teeth for their entire lives, and having a healthy mouth is essential to achieving that goal. By straightening teeth and minimizing the potential impact of malocclusion, patients have a much better opportunity to preserve their natural teeth throughout their lives. Invisalign is a comfortable option for giving patients healthier mouths and new smiles because it is nearly invisible, easy to keep clean, and is removable. Straight white teeth and beautiful smiles are wonderful side benefits.
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About the Author
This article was written by Catherine Sherry, DDS, who is a general practitioner in Yukon, Oklahoma.