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VOLUME 01 / ISSUE 01 The Academy for Clear Aligner Therapy the AmericanJournal Academy of Cosmetic Orthodontics MOVING not removing ENAMEL. PEER-REVIEWED SOLUTIONS that will make Clear Aligner Treatment THAT MUCH EASIER. Like this Journal? start receiving your quarterly issue today! The official academy for Clear Aligner Therapy. Become a member TODAY! www.aacortho.com AACO Board Members Dr. David Galler: President the Dr. Mark Hodge: Vice President Dr. Perry Jones: Director of Education Dr. Jeffrey Galler: Editor AmericanJournal Academy of Cosmetic Orthodontics Dr. Len Tau: Director of Media Relations Dr. Bruce McFarlane: Orthodontist, Advisory Board Article is Peer Reviewed Article offers CE Credit at www.aacortho.com Dr. David Harrnick: Orthodontist, Advisory Board Dr. Sandi Bosin: Orthodontist, Editorial Board Case Reports Dr. Peter Rivolli: ClearCorrect Clinical Expert Dr. Yana Shampanksy: Invisalign Expert 2 Upper Lateral Incisor Crossbite with Dr. Lori Trost: MTM Clinical Expert Lower Premolar in Lingual Version by Dr. Cathy Sherry 4 Invisalign Correction of a Teenager’s Class 2 Division 1 Malocclusion by Dr. David J. Harnick 8 Upper Arch Spacing and Lower Editorial Arch Overcrowding I’ve been reading numerous by Dr. David Galler dental journals every Practice Development month for many years, 14 The Economics of Buying vs. but don’t remember ever Renting Your Next Office actually reading an editorial completely, from beginning by Jake Jacklich to end. 16 “Doctor, I’ve been your patient for I resolved that in this, my first 10 years; how come you never editorial for the Journal of the American mentioned orthodontics before?” Academy of Cosmetic Orthodontics, by Gary Kadi I would write an editorial that readers Retention would, in fact, read from the very first to the very last word. 20 Post-Treatment Fixed Lingual Retainers by Arlen J. Hurt So, here goes. In this Journal, we will endeavor to Product Review give our members content that will 26 Ultradent’s Opal Seal enable them to treat patients with by Dr. David Harnick less stress, greater productivity, Innovative Techniques and greater profitability. That’s it. Thank you for joining us. 28 Success in Rotating or Extruding Canines by Dr. Perry Jones The Lighter Side 34 Maggie’s TMJ Dr. Jeffrey Galler by Dr. Jeffrey Galler Editor American Academy of Cosmetic Orthodontics is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program Advertising: [email protected] provider are accepted by AGD for Fellowship, Mastership and Editorial: [email protected] membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. Cover illustration by Ari Steiner The current term of approval extends from 10/1/2012 to 9/30/2013. Provider ID# 350507 Journal designed by AetherQuest Solutions Case Reports Upper Lateral Incisor Crossbite with Lower Premolar in Lingual Version by Dr. Cathy Sherry A 58 year-old female patient presented with a Class I occlusion, Treatment sequence 40% overbite, and 3mm overjet. She had lower anterior We delivered her first set of aligners along with whitening gel, overcrowding and attrition, with tooth #20 lingually inclined, which the patient applied for two weeks, inside the aligners. and tooth #7 in crossbite. She had mild periodontal recession. The resultant dramatic improvement in her appearance was This case was clearly going to be complex and challenging, a very effective positive reinforcement, and gave her added but the patient was very enthusiastic about the improvements incentive for continuing her excellent compliance. in esthetics and oral health that could be achieved, and was At her second appointment, we placed the indicated clearly going to be a very compliant, cooperative patient. attachments, as per ClinCheck, and performed a minimal This case illustrates how Invisalign clear aligner treatment can amount of interproximal reduction (IPR). The IPR was succeed in correcting a considerable amount of overcrowding accomplished using diamond strips, primarily in the lower without resorting to extractions, and also correct a significant left quadrant, and averaged 0.2 - 0.3 mm per tooth. anterior crossbite. Achieving a healthier, more esthetically At each visit, we made sure to check all the relevant contact pleasing smile and facial profile was extremely gratifying to points with dental floss, to ascertain that the involved teeth both the patient and clinician. had sufficient room to move into proper position. Dr. Sherry practices in Yukon, Oklahoma and is a graduate of the University of Oklahoma College of Dentistry. She practices cosmetic dentistry as well as orthodontics, and won the award for the best orthodontic case, at last summer’s annual Invisalign Meeting in Las Vegas. That case was also recently featured in the June issue of Inside Dentistry. She explains that, “My philosophy is that the least amount of dentistry is often the best. I would prefer to move teeth first then restore if necessary. Frequently, a very appealing esthetic result can be achieved through clear aligner therapy, alone.” [email protected] Pre- and post- treatment retracted smile. 4 the Journal: volume 01- issue 01 Pre- and post-treatment of the mandibular arch. Pre- and post-treatment of the maxillary arch. Refinement This strategy worked successfully, and final, Vivera retainers After the patient wore the first 20 aligners, it was clear that a were ordered, in order to retain the outcome and help prevent refinement would be needed, and that #7 and #20 would need relapse. We prefer Vivera retainers because of the consistent considerably more repositioning. A refinement like this simply strength and retention that they provide. involves removing the attachments, taking new impressions, and beginning a new treatment phase. Summation The total active treatment time for this very gratifying case was The upper arch refinement and completion required only 16 months, and the average appointment required 15 minutes. four additional aligners, while the lower teeth required 13 additional aligners. Besides the obvious and dramatic improvement in the patient’s appearance, correcting the traumatic occlusion of the Ordinarily, we instruct patients to remove their aligners while malpositioned teeth provided for a healthier and more stable eating; however, we find that when one or more teeth are in occlusion, and correcting the overcrowded teeth significantly crossbite, it is extremely helpful to have the patient eat while improved her periodontal health. the aligners are being worn. By having the patient do this, we can minimize occlusal interferences that can hinder the The patient was very pleased with the change in her facial successful correction of the crossbite. Fortunately, this patient profile, in the way “her chin wasn’t so pointed,” and in the way n was extremely cooperative and compliant. her friends commented on how much younger she appeared. This second phase of treatment, or refinement phase, required There is a 30 second video of this patient on YouTube, titled, a 0.4 mm interproximal reduction between the upper centrals. “How old do you think this Invisalign patient is?” This IPR provided the extra space needed for the upper right lateral to finally move into position. It is, of course, always To access the video, go to: http://bit.ly/OntIHg. beneficial to be as conservative as possible when performing interproximal reduction. Final touches When the final upper aligner was delivered, we noted that a minor amount of rotation was still needed on the upper right lateral. To accomplish that, we placed a dimple, in the aligner, on the mesial-lingual of tooth #7, to apply rotation pressure to the tooth. This dimple functions much like a rotating wedge in conventional braces. the Academy for Clear Aligner Therapy 5 Upper Lateral Incisor Crossbite with Lower Premolar Case Reports in Lingual Version by Dr. David J. Harnick Introduction Introduced by Align Technology in 2008, Invisalign Teen is an excellent alternative to fixed appliances for some teenagers. Initially, Invisalign was primarily used to correct minor alignment, crowding, and spacing issues 1-4. However, as Clear Aligner Treatment (CAT) appliances gained acceptance this treatment modality was increasingly used to correct more complex malocclusions as well 5-9. Today, these techniques can be used predictably on teenagers. There are a number of teenagers that would prefer not to wear fixed appliances, for the obvious reasons. Since there is occlusal coverage during the entire treatment duration, Invisalign treatment presents new opportunities and challenges that need to be clearly understood. All types of malocclusions exist in these younger patients, including complicated skeletal disharmonies. Many of the patients are still growing. This case report of a Class 2 malocclusion demonstrates some important Figure 1: Initial montage photographs. Note the narrow arch forms with factors in utilizing Invisalign Teen to achieve the best esthetic palatally inclined buccal segments. Also, because of the end-on occlusion and functional result. of the canines, there is flattening of the maxillary canine cusp tips. Diagnosis Chief Complaint: This 14 year old female’s chief complaint was a “bite problem.” Her medical history was clear. Facial: Symmetrical from frontal view. Normal incisor and gingival display for her age. Profile is within normal limits. The smile photograph shows palatally inclined buccal segments. Fig.1. Dr. Harnick is in the private practice of orthodontics in Albuquerque, New Mexico. Diplomate of the American Board Figure 2: Initial panoramic radiograph. Note the moderately short root of Orthodontics. development of the maxillary central incisors. Master of the Academy of General Dentistry. www. harnickorthodontics.com Radiographic: Panoramic radiograph shows that all wisdom teeth are developing. Teeth #s 8, 9 have short root formation. Fig.2. Cephalometrically, she has an ANB of 6 degrees which is suggestive of a Class 2 skeletal problem. Her incisors are of normal angulation. Fig.3.