Transcript
Case Presentation of a typical orthodontic case of moderate difficulty using the Invisalign
method
Name: A S, DMD IV, 2012Date: March, 2012
OcclusionRight Side Molar Class: I Canine Class:
I
Dental Midline
Upper: On Lower: On
Left Side Molar Class:
N/A Canine Class: I
Pre-Treatment
Intra-Oral Examination
Teeth Present:11-17, 21-25, 2731-35, 37, 41-47
Arch Shape: Upper: Normal to tapered
Lower: Normal to tapered
Pre-Treatment
Intra-Oral Examination
Clinical Findings: Molars: Class I on right; Missing 26 & 36 on left Canines: Class I Missing: 18, 26, 28, 36, 38 & 48 OJ: 2 mm on right; 3 mm on left OB: 50% Mild crowding on both upper & lower incisors
Pre-Treatment
Intra-Oral Examination
Amount of Crowding:
Upper Arch: Mild ~ 3 mm
Lower Arch: Mild ~ 3mm
Pre-Treatment
Panoramic Radiograph Analysis
Clinical Findings:
No suspected decay or bone pathologyPermanent dentition: 26 teeth present (Missing 8’s, 26 & 36)
Pre-Treatment
Cephalometric AnalysisAngles Ceph.
ValuesNormal
Skeletal Measurements
SNA 79.5 81 ± 3
SNB 75.0 78 ± 3
ANB 4.5 3 ± 2
Witts -4.0 2 mm ± 2mm
Facial ∠ 86.0 88 ± 4
MPAST 38.0 32 ± 3
Y axis 60.0 60 ± 4
Dental Measurements
(UI,NA) 16.0 23 ±6
(LI,NB) 23.0 27.5 ±5
(UI,LI) 135.0 130 ± 7
(LI,MP) 91.0 91.4 ± 4
Pre-Treatment
Dental Cast AnalysisBolton Analysis – Ideally 77%
• UA (Σ 13-23) = 41.7 mm• LA (Σ 33-43) = 31.4 mm
• ( 31.4 / 41.7 ) x 100 = 75.3%
Tooth Upper right Upper left Ideal
Central Incisor 8.5 8.0 8.85
Lateral Incisor 5.5 6.0 6.9
Canine 6.7 7.0 7.88
Tooth Lower right Lower left Ideal
Central incisor 5.1 5.0 5.5
Lateral incisor 5.3 5.4 6
Canine 5.4 5.2 6.95
Pre-Treatment
Summary of Findings Dental:
Molars: Class I on right; Missing 26 & 36 on left Canines: Class I Missing: 18, 26, 28, 36, 38 & 48 OJ: 2 mm on right; 3 mm on left Increased OB (50%) Lower dental midline deviates 2 mm to the left upon opening Mild crowding on both upper & lower incisors Normal to tapered arch shapes 6 mm of upper incisors showing at rest Bolton analysis: 75.3%
Skeletal: Symmetrical face; Normocephalic Decreased lower face height Slight-moderate convex profile Pre-Treatment
Diagnosis
Class I molar/canine Maxillary anterior crowding Mandibular anterior crowding 50% overbite Flat to slight curve of spee
Pre-Treatment
Objectives of Treatment
Pre-Treatment
Resolve patient’s chief complaint of crowding
Decrease overbite Maintain class I molar/canine
relationship Maintain nasolabial angle Maintain midlines
Exactly One Year Later
Post-Invisalign Treatment
OcclusionRight Side Molar Class: I Canine Class:
I
Dental Midline
Upper: On Lower: On
Left Side Molar Class:
N/A Canine Class: I
Post-Invisalign Treatment
Intra-Oral Examination Teeth Present:11-17, 21-25, 2731-35, 37, 41-47
Arch Shape: Upper: Normal to tapered
Lower: Normal to tapered
Crowding:Upper: NormalLower: Normal
Post-Invisalign Treatment
Patient not satisfied with the final position of tooth #32 & tooth #41
Post-Invisalign Treatment Problems
Post-Invisalign Treatment
Dimple-maker! Dimples added to:
Tooth #32 - distal buccal incisal area Tooth #41 - distal buccal incisal area
IPR on both tooth #32 & #41 Both teeth rotated into proper position within 2 weeks Dimples then added to:
Tooth #31 - distal buccal incisal area & mesial lingual incisal area Patient now satisfied with final results
Post-Invisalign Treatment Solution
Post-Invisalign Treatment
Post-Invisalign Treatment Solution
Post-Invisalign Treatment
Pre-Treatment
Post-Treatment
Post-Treatment
Pre-Treatment
Post-Treatment
Intra-Oral Examination
Decrease in both overbite & overjet
Arch Shape:
Upper: Normal to tapered
Lower: Normal to tapered
Intra-Oral Examination
Pre-Treatment
Post-Treatment
No change from pre-treatment:
Panoramic Radiograph Analysis
Clinical Findings:
No suspected decay or bone pathologyPermanent dentition: 26 teeth present (Missing 8’s, 26 & 36)
Post-Treatment
Cephalometric AnalysisAngles Ceph.
ValuesNormal
Skeletal Measurements
SNA 80.0 81 ± 3
SNB 75.0 78 ± 3
ANB 5.0 3 ± 2
Witts -4.5 2 mm ± 2mm
Facial ∠ 84.0 88 ± 4
MPAST 39.5 32 ± 3
Y axis 63.0 60 ± 4
Dental Measurements
(UI,NA) 12.0 23 ±6
(LI,NB) 22.5 27.5 ±5
(UI,LI) 141.0 130 ± 7
(LI,MP) 87.5 91.4 ± 4
Post-Treatment
Dental Cast AnalysisBolton Analysis – Ideally 77%
• UA (Σ 13-23) = 42.4 mm• LA (Σ 33-43) = 32.2 mm
• ( 32.2 / 42.4 ) x 100 = 75.9%
Tooth Upper right Upper left Ideal
Central Incisor 8.3 8.1 8.85
Lateral Incisor 5.8 5.8 6.9
Canine 7.3 7.1 7.88
Tooth Lower right Lower left Ideal
Central incisor 5.2 4.7 5.5
Lateral incisor 5.1 5.3 6
Canine 6.1 5.8 6.95
Post-Treatment
Summary Dental:
Molars: Class I on right; Missing 26 & 36 on left Canines: Class I No atempts made to resolve the skeletal discrepancy OJ: 2 mm on right; 1 mm on left OB (30%) - Decreased from 50% at pre-treatment Lower dental midline deviates 2 mm to the left upon opening Crowding issues on both upper & lower incisors resolved
(addressed CC)
Normal to tapered arch shapes 6 mm of upper incisors showing at rest
Skeletal: Symmetrical face; Normocephalic with dolichocephalic tendenty
remained Slight-moderate convex profile remained
Post-Treatment
Conclusions
• Overall, patient is very satisfied as her chief complaint has been addressed.
• Opted for Invisalign type retainers.• IPR avoided any flaring of the dentition • The upper incisors were not torqued enough
but the esthetic result is still very acceptable.
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