Case Selection with Invisalign: The to a Outcome...1 Case Selection with Invisalign: The First Step to a Successful Outcome 2 3 • DDS ( 1986) and Diploma of Orthodontics from the

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Case Selection with Invisalign:

The First Step to a Successful Outcome

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• DDS ( 1986) and Diploma of Orthodontics from the University of Toronto (1991)

• Orthodontic practice in Toronto, Canada, focused on Cosmetic and Rehabilitative Orthodontics.

• Invisalign Super Elite Provider and member of the Aligntech Institute Faculty

• Lecturer at the University of Toronto, and Guest Lecturer at Tel Aviv University and Hadassah University in Jerusalem

• Featured speaker at the Pankey Institute, Invisalign Forum and Invisalign Summits, and numerous Align events worldwide.

• Member of the AAO and CAO, and other dental organizations

• Married to Ellen Dayan ( Restorative Dentist ), and 4 great children, Laurel, Ariel, Jamie, and Jory

Dr. Willy Dayan

www.orthoclined.com [email protected]

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•Mild Case Selection for Aligner Correction

•Moderate Case Selection for Aligner Correction

•Severe Case Selection for Aligner Correction

Malocclusion Criteria for Aligner Orthodontics

•What is the Orthodontic Treatment Plan Before the ClinCheck

•What will be Required Besides Braces and Wires

•How Would the Wires Look ........ Straight or Not

Aligned Upper and Lower Arches is Not a Treatment Plan

•Mild Case Selection for Aligner Correction• Alignment Correction• Minor Vertical and Sagital Correction• No Significant Root Movements




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Go to Clincheck

Mild Case Selection

Aligner NumbersMx: 25+6=31Md: 25+6=31

Treatment Time: 15 Months

Smart Force Systems and Refinement Aligners are your Friend!

Lets not Doctor Everything!!

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Refinement Aligners are your Friend!

Before

Stage 11Md rfn

Go to Refinement Md

TrackingStage 11

Go to Refinement Mx



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Before

After

Detailing Aligners are your Friend!

Treatment Efficiency......Need Staff Systems!!!!


Treatment Appointments: 9(Including Impressions and debond and retention)

+1: Impression+2: Insert Aligners and attachments+5: Invisalign progress at 9,11,15,21,6+1: Debond Attachments and Retention

Traditional Appointments: 12(Including Start and debond and retention)

+1: Bond+7: Arch Changes and Adjustments+2: 2 emergencies per year+2: Debond Attachments and Retention

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Case 5

Class I Mild Crowding, High Canine

The Advantages of Optimized Attachments

Smart Force Systems in Operation

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Chief Complaint: •I don’t like my smile •My canine stopped coming down

Significant Clinical Findings: •Class I Malocclusion•High upper right canine•Mild crowding

Records: •Panoramic Xray: WNL•Lateral Cephalometric Xray: WNL

Go to Clincheck Final

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The Advantages of Optimized Attachments: Smart Force Systems in Operation

Par 2 or Par 3 Orthodontic Case

One Modification....Treatment Plan 2 Accepted

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Before

Progress

LastAlignersTracking

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Treatment Efficiency



+1: Impression+2: Insert Aligners and attachments+4: Invisalign progress at 9,15,21,25+1: Debond Attachments and Retention

Vertical Challenges: In the Developing Dentition

InitialRecords

Go to 1st Order

Go to 2nd Order

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Before Progress: Middle of 1st Order

Note how aligners guide maxillary cuspids as they erupt.

Go to 1st Order

Go to 2nd Order

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Before

Near End of1st order

Near End of 2nd Order

Go to 1st Order Go to 2nd OrderFinished Retainer #11

From 2nd Order

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Before

Go to 1st Order Go to 2nd Order

Finished Retainer #11From 2nd Order

After


AfterBefore


•Moderate Case Selection for Aligner Correction• Alignment Correction• Need for Vertical and or Sagital Correction• Some Root Movements Required



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Go to Final ClincheckGo to Clincheck 1

Enhanced Restorative / Prosthetic / Periodontal Dentistry Using Orthodontics

Vertical Challenges: Deep Anterior Overbite with Adequate Vertical Smile

Vertical Challenges: Deep Anterior Overbite

First ClinCheck Final ClinCheck

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+1: Impression+2: Insert Aligners and attachments+4: Invisalign progress at 9,15,21,25+1: Debond Attachments and Retention

Vertical Challenges: Deep Anterior Overbite with Adequate Vertical Smile


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Vertical Challenges: Deep Anterior OverbiteAre they all the same?


Vertical Challenges: Deep Anterior OverbiteAre they all the same?

Before

Deep‐bite, with desire to open vertical dimension of occlusion with mandibular posterior eruption.

Vertical Challenges: Deep Anterior Overbite with Inadequate Vertical Smile

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Before

Deepbite, with desire to open vertical dimension of occlusion with mandibular posterior eruption.

During


When you want an increase in face height…..Braces can be better and faster

Posterior eruption: When we do want it!!!

Go to Clincheck

Before

During

Before After



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Go to ClinCheck37

NM:MXD28 No RF!

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Translating Roots Mesially or Distally

What the tooth needs to feel, and what we need to see!

Translating Roots Mesially or Distally

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Before

After

BeforeBefore AfterAfter

NM:MXD28 No RF!



+1: Impression

+2: Insert Aligners and attachments+4: Invisalign progress at 9,15,21,26+1: Debond Attachments and Retention

Anticipate The Challenging Movement…90/10 Philosophy!!

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The LL3 needs much root tipping.If one notices non‐tracking mid‐tx.

Apply 90/10 thinkingduring remaining aligners.

Anticipate The Challenging Movement…90/10 Philosophy!!

Before

After

No Mistakes....Only one more way of how not to do it!!!!

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No Mistakes....Only one more way of how not to do it!!!!

Lets not Doctor Everything!!Just what Needs Doctoring!!

Go toClinCheck

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Tracking NearEnd

Progress Near End

Before

After

Doctor what Needs Doctoring....and Lets not Doctor Everything!

Aligner NumbersMx: 23 + 0 = 23Md: 23 + 0 = 23

Treatment Efficiency

Treatment Appointments: 7+1: Scan+2: Insert Aligners and attachments+3: Invisalign progress 9,15,21+1: Debond Attachments and Retention

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Sagital Challenges: Class II Correction: Elastics

Class II Elastics

Go to Clincheck

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Class II Correction During Invisalign

•Continuous Staging•IPR delayed until stage 21•Bite Jump at end of Clincheck

Sagittal Challenges: Class II Correction: Elastics

Before

Class II Elastics: Stage 9

Progress: Stage 9

Before After

Treatment Efficiency ( stopped refinement at #5)


Treatment Appointments: 9+1: Impression+2: Insert Aligners and attachments+5: Invisalign progress and refinemnt at 9,15,21,2,5+1: Debond Attachments and Retention


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Initial

Final

1 year Retn.Mx:Vivera NightsMd: Fixed Wire

Note posterior inter‐occlusalspace closing slowly.


If it Works for Class II...what about Class III: Class III Correction: Elastics

Class III Elastics

Go to 1st Order

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Note how elastics have corrected the crossbite and class III conditions morethan Clincheck shows at same stage.

Go to 1st Order

Stage 15


Before Progress

Go to 1st Order Go to 2nd Order ( Ret/Ref)

Patient did not wear last lower aligners.NO LOWER IPR!!!

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Not finished yet.

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Sagittal Challenges: Crossbite Correction: Invisalign Expansion and Elastics Support

Final Records Previous

Orthodontics

Original Ceph

InitialPhotos

Treatment Plan: Invisalign expansion supported with crossbite elastics and selected intrusion to reduce canted occlusalplane.

Go to ClinCheck1st Order

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Crossbite Elastics Set‐up.....•What is the Orthodontic Treatment Plan Before the ClinCheck•What will be Required Besides Braces and Wires•How Would the Wires Look ........ Straight or Not

Stage 0 Stage 9 Stage End 1st Order

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Before Progress Stage 9

Crossbite corrected clinically............ even before it is corrected in ClinCheck!

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Before

Final

End of 1st Order

Solving the “posterior openbtie” with anterior intrusion

and a bite jump.

Go to ClinCheck2nd Order

Go to ClinCheck1st Order

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Before Final

Go to ClinCheck

Working Smarter …. Not Harder!!

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Go to ClinCheck


Avoiding the Openbite!

Before Final



Treatment Appointments: 6+1: Scan+2: Insert Aligners and attachments+2: Invisalign progress at 9,15,+1: Debond Attachments and Retention

Serious Doctor Time Appts

3Consult,3,15

Before FinalWorking Smarter …. Not Harder!!

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StartRFNMT

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Before

StartMCC.

After


VT:MXD27/45, MCC30/30 RFMXD10

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Before

After

Before After


StartRFNMT

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Before

StartMCC.

After



It took me and my partner patient

3 shotsto get the ball in

the hole!

Go to ClinCheck

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Go toClinCheck

40 Aligners

Before After Retainer Refinement

AfterRetainer Refinement

BeforeRetainer Refinement

Before After Retainer Refinement

After Retainer RefinementBefore Retainer Refinement

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Sagittal Challenges: Class III Correction: Lower Incisor Extraction

Go to ClinCheck Final

Go to ClinCheck Trial IPR


Maxillary IPRLower Incisor Extraction

Progress Pictures


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Refinement In Mandible Only

6 Aligners with 0.2mm IPR from 3 to 3 increase overjet.

Time for Refinement Aligners for Finishing Details


Aligner NumbersMx: 36 + 0=36Md: 36 + 6=42


+1: Impression+2: Insert Aligners and attachments+7: Invisalign progress at 9,15,21,27,33, 36,6+1: Debond Attachments and Retention

Before

After


Initial Records

Go to Clincheck 5 Approved

Go to Clincheck 1 Proposal

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Still in Treatment.....My next biggest openbite closure!!!

Stage 0

Stage 9

Stage 9 Progress Appt.

Go to Clincheck2nd Order

Go to Clincheck 5 Approved(1st Order)

Par 2 or 3 or 4 or 5 or….

Orthodontic Case

Progress....Not Yet 2 Years!!!

All attachments off .... Taking Records for 3rd OrderWe are on the Green….Putting Now!!

It’s His Birthday!!Go to

3rd Order

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Before Final

Anterior Guidance........No Elastics and No TADS!!

Vertical Challenges: Anterior Openbite

Before Final



Hard Posterior contacts

Go to1st Order

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Before

End of 1st Order

Go to2nd Order

Go to1st Order

End of 2nd Order

Go to3rd Order = RR


Before Final

2 years and a Par 3


In time for the Wedding!


Invisalign and Braces...the Perfect Couple!!

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Go to Clincheck1


BUT THIS PATIENT WILL NOT HEAR ABOUT BRACES!!!!!

Go to Clincheck2( mcc @ stg 4)

Hard Posterior contacts

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Levelling Deep Curve of Spee In Both Arches

If we use a reverse curve of spee aligner in both arches.....That means extrusion of bicuspids in both arches.....

That mean occlusal interferences and heavy occlusal contacts in posteriors and .....

IT SHOULD NOT BE RESOLVED BY INTRUSION OF POSTERIORS!!!!!

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In a deep bite if we use opposing curve of spee levelling wires, by definition we are purposefully creating posterior occlusal interferences to open the bite!

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Go to Clincheck1

Go to Clincheck2( mcc @ stg 4)

Before Stage 37


Go to Clincheck1

Go to Clincheck MCC

( mcc @ stg 4)

Before End of 1st Series

Go to 2nd Order

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New G5 Features Now Available…….IT CAN ONLY GET BETTER!!!!

•What is the Orthodontic Treatment Plan Before the ClinCheck

•What will be Required Besides Braces and Wires

•How Would the Wires Look ........ Straight or Not

Aligned Upper and Lower Arches is Not a Treatment Plan





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Dr. Willy Dayan

•[email protected]

•www.orthoclined.com

Case Selection with Invisalign: The to a Outcome...1 Case Selection with Invisalign: The First Step to a Successful Outcome 2 3 • DDS ( 1986) and Diploma of Orthodontics from the

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