Case Report

VI. Panoramic radiograph VII. Final ClinCheck treatment plan Dr Peter Miles after treatment Peter Miles received his dental degree with honours from the University of Queensland in Australia and his Masters degree in orthodontics from the University of Pittsburgh in the USA, and he is Australian Orthodontic Board certified. He was a part-time senior lecturer in orthodontics at the University of Queensland for over 10 years and is currently a visiting lecturer at Seton Hill University in the USA. Dr Miles is also a reviewer for several journals, including the American Journal of Orthodontics and Dentofacial Orthopedics and is on the editorial board of The Angle Orthodontist. He has lectured at various national and international meetings, including the American Orthodontic Congress, the British Orthodontic Congress, the World Orthodontic Congress and the Moyers Symposium. Dr Miles has published over 45 articles on clinical topics relating to treatment effectiveness and is one of the editors and authors of the book Evidence Based Clinical Orthodontics. He currently runs his own private practice in Caloundra, Queensland. Dr Miles is a Key Considering the Opinion Leader with Invisalign Australia. mandibular retrusion and straight lip profile of the patient, the

non-extraction In this case, the top retainer had holes is more convenient in cases such as approach with cut in the buccal surface for button this where the patient presents with placement, but the retainer still covered teeth crowding, given the excellent fit the Invisalign Full the occlusal and lingual surfaces to the aligners provide, minimising any prevent palatal rolling. discomfort. Aligners made from the treatment option • As done for this patient, the lower SmartTrack material are also easy to was preferred. retainer can be cut short stopping insert and remove by patients. In this at the right second premolars case, no trimming of the aligners was Following treatment, to allow for the vertical and lingual required. Additionally, in my experience, rolling of the molars. This helps in the more the teeth are aligned, the less the crowding vertical settling and maintenance of the the aligner wear interval needs to be, was relieved, the crossbite correction. which is encouraging to patients. Treating an Adolescent • Patients should be advised to carefully crossbites corrected insert and remove aligners made with Conclusion the SmartTrack material. Patients This case involved significant and the posterior right should be instructed to use Chewies malalignment that compromised the Patient with Deep Overbite for at least the first few days of each occlusion settled. The aesthetics of the patient’s smile and new aligner, but can also be told therefore his confidence. Considering that they can use them for the entire deep bite was also the mandibular retrusion and straight lip treatment period. improved and the profile of the patient, the non-extraction and Crowding with the • Discomfort due to edge rubbing can be approach with the Invisalign Full alignment almost fully easily overcome by smoothening the treatment option was preferred. Following aligner with a nail file at home or at treatment, the crowding was relieved, the corrected in the lower the clinic. Invisalign System crossbites corrected and the posterior arch; thus, the patient’s • Refinement aligners can be over- right occlusion settled. The deep bite was expanded in the first molar regions to also improved and the alignment almost treatment goals were ensure transverse correction, as done fully corrected in the lower arch; thus, the for this patient. patient’s treatment goals were achieved achieved with the with the Invisalign System along with the Invisalign System Impact on clinical practice use of elastics and IPR. The patient was very happy with the treatment outcome. along with the use This case demonstrates that the Invisalign System is effective at relieving Author disclosure crowding and correcting crossbites Dr Peter Miles of elastics and IPR. Dr Peter Miles was provided an honorarium from Align in conjunction with elastics and IPR. BDSc, MDS, Technology, Inc., for his contribution towards the MRACDS(Orth), FICD Treatment with the Invisalign System creation of this case report.

This case report is intended for dental and healthcare professionals, and is subject to applicable local laws, regulations and guidelines. This case report is intended for dental and healthcare professionals, and is subject to applicable local laws, regulations and guidelines. This case report is intended for dental and healthcare professionals, and is subject to applicable local laws, regulations and guidelines. INVISALIGN, CLINCHECK, and ITERO ELEMENT, among others, are trademarks and/or service marks of Align Technology, Inc. or one of INVISALIGN, CLINCHECK, and ITERO ELEMENT, among others, are trademarks and/or service marks of Align Technology, Inc. or one of INVISALIGN, CLINCHECK, and ITERO ELEMENT, among others, are trademarks and/or service marks of Align Technology, Inc. or one of its subsidiaries or affiliated companies and may be registered in the U.S. and/or other countries. its subsidiaries or affiliated companies and may be registered in the U.S. and/or other countries. www.invisalign.com its subsidiaries or affiliated companies and may be registered in the U.S. and/or other countries. III. Initial ClinCheck treatment plan buccal of the maxillary left canine for IV. Triangular 1/4” 6 oz elastic for Treatment outcome a Class II 5/16” 3.5 oz elastic that was settling of the posterior occlusion The crossbites of the first molars were to be worn on the left side during The patient, a teenage male, was 17 years of age at the time of first presentation. The patient The Invisalign System on the right side corrected with the support of elastic wear. the day. was concerned with the crowding of his teeth and a retained top left deciduous canine which has the advantage The posterior right buccal occlusion was • Aligners 18 to 32 were issued and the difficult to settle vertically; however, this was subsequently extracted. There was significant malalignment, which compromised the molar cross-elastic stopped on the of disoccluding was eventually achieved over a 2-month patient’s smile and his confidence. left side, but continued on the right period with the support of a triangular at night. The final IPR was performed teeth and therefore elastic worn nightly in conjunction with and the Class II elastic wear was unlocking the a removable retainer. The deep bite was continued on the left side during the improved and the alignment almost fully day. The aligner interval was reduced occlusion during corrected in the lower arch, however, to 10 days and then 9 days at around I. Intra- and extra-oral images before treatment Clinical presentation the patient decided to accept the minor aligner 21. crossbite correction. It rotation of tooth 41 as he was attending The patient presented with • Aligners 33 to 40 were issued to be also splints the teeth university which, as mentioned previously, worn at 8-day intervals. The molar a significant overjet, deep was a significant drive away. cross-elastic on the right side was retainers. The top retainer had holes cut together preventing in the buccal surface, but still covered the overbite as well as severe stopped but the Class II elastic wear Clinical tips was continued. unpredictable occlusal and lingual surfaces to prevent crowding and crossbites in the elastic rolling the upper molars back • The Invisalign System has the both arches, resulting in a • Aligners 41 to 45 were issued; the teeth movement into crossbite. The lower retainer was cut advantage of disoccluding teeth and patient was instructed to stop at therefore unlocking the occlusion narrow smile. distal to the right second premolar teeth aligner 45 as the last three aligners due to unwanted to allow vertical and lingual movement of during crossbite correction. It also were virtual c-chain aligners which interferences as the the lower molars, which helped both the splints the teeth together preventing Clinical findings extraction of all four second premolar were not required as the anterior vertical settling and maintenance of the unpredictable teeth movement due teeth. Considering the mandibular retrusion contacts were firm. The aligners were • Mild Class II facial profile with a Class I crossbite corrects. crossbite correction. to unwanted interferences as the and straight lip profile of the patient, replaced every 7 days. molar relationship. Treatment was completed in March crossbite corrects. the non-extraction option was chosen, Refinement phase using 14 aligners. 2017. New impressions were taken for • Vacuum-formed retainers can be • Overjet of 10 mm. along with upper and lower interproximal • All attachments were removed and manufacture of vacuum-formed retainers designed to prevent the elastic from • Deep overbite with the first molars reduction (IPR), to relieve the crowding. Pre-Treatment a scan performed to determine the • Optimised Rotation Attachment on that were to be worn nightly and covering rolling the upper molars palatally and in crossbite. Commencing treatment with the non- additional aligners needed to refine tooth 33. all the posterior teeth. potentially re-creating the crossbite. extraction approach allows the conduct • Constricted and V-shaped upper and the alignment and occlusion. of a ‘therapeutic diagnosis’, whereby the • Optimised Deep Bite Attachments on lower arches. decision to extract can be made, if needed, • In August 2016, the additional teeth 35, 44 and 45. V. Intra- and extra-oral images after treatment • Both arches presented with during the course of the treatment. aligners were issued. Aligners 1 to 7 • Optimised Extrusion Attachment on 5–6 mm crowding. were worn at 8-day intervals. tooth 43. • No lower wisdom teeth and deep Treatment details • The patient unfortunately lost restorations in his upper first molars aligner 7 and was instructed to stay Retention Active treatment time (symptomless), as shown in the on aligner 6 until the other aligners During the treatment course, the patient 17 months. panoramic radiograph. were issued. graduated high school and needed • Thick tissue type in the lower anterior • The patient was stopped on to move location to be closer to his Aligners used region and good oral hygiene, as a aligner 14 as the last three were chosen university, approximately 90 result of which the risk of lower incisor Initial treatment phase using 45 sets virtual c-chain aligners which were minutes’ drive away. He was informed of of aligners. not required. II. Panoramic radiograph before treatment gingival recession was considered low. a residual lower incisor rotation and that • Treatment commenced in April 2015, the right side posterior buccal occlusion Attachments Treatment goals with attachments bonded and the required settling. He opted to stop aligner first four aligners issued and worn at Initial treatment phase treatment and transition to retainers • Relieve crowding in both arches. 2-week intervals. • Optimised Root Control Attachments over the Christmas holidays. The use of • Achieve ideal overjet and overbite. • Aligners 5 to 10 were issued and on teeth 14, 15, 24, 25, 43 and 44. elastics to settle the occlusion was also discussed with the patient and agreed Post-Treatment • Correct alignment. buttons were attached for 1/4” 6 • Optimised Rotation Attachments on upon. Attachments were removed and • Crossbite correction. oz cross-elastics. The patient was teeth 13, 33, 34 and 45. instructed to wear the cross-elastics fixed-wire retainers were bonded in both • Optimised Deep Bite Attachment on for 12 hours at night on the palatal of arches (upper 2–2 and lower 3–3). In tooth 35. Treatment approach the upper first molars to the buccal addition, vacuum-formed retainers were Conventional horizontal bevel gingival Treatment options were discussed with the of the lower first molars; the initial • issued to be worn nightly. attachments (3 mm) on teeth 12, 21 patient and his parents. One of the options IPR was performed. In January 2017, the posterior occlusion and 23. was a non-extraction approach involving • Aligners 11 to 17 were issued and was again discussed and buttons bonded transverse and sagittal expansion with further IPR performed. The cross- Refinement phase on the right side for a triangular 1/4” 6 oz the Invisalign Full treatment option. The elastics were continued nightly, while • Optimised Root Control Attachments elastic that was to be worn for 12 hours other option under consideration involved a clear button was bonded to the on teeth 11, 12, 13 and 34. every night along with the removable

This case report is intended for dental and healthcare professionals, and is subject to applicable local laws, regulations and guidelines. This case report is intended for dental and healthcare professionals, and is subject to applicable local laws, regulations and guidelines. This case report is intended for dental and healthcare professionals, and is subject to applicable local laws, regulations and guidelines. INVISALIGN, CLINCHECK, and ITERO ELEMENT, among others, are trademarks and/or service marks of Align Technology, Inc. or one of INVISALIGN, CLINCHECK, and ITERO ELEMENT, among others, are trademarks and/or service marks of Align Technology, Inc. or one of INVISALIGN, CLINCHECK, and ITERO ELEMENT, among others, are trademarks and/or service marks of Align Technology, Inc. or one of its subsidiaries or affiliated companies and may be registered in the U.S. and/or other countries. its subsidiaries or affiliated companies and may be registered in the U.S. and/or other countries. its subsidiaries or affiliated companies and may be registered in the U.S. and/or other countries.